45D0992887 CLIA NUMBER - LYTLE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 45D0992887
  • Facility Name: LYTLE FAMILY PRACTICE
  • Facility Address: 19432 DAVIS STREET
    LYTLE, TX
    ZIP 78052
  • Facility Phone: 830 109-9960
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: GLENDON S. HACK
  • NPI Number: 1790870327
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 45D0992887
LAB Type Physician Office
Facility Name LYTLE FAMILY PRACTICE
Street 19432 DAVIS STREET
City LYTLE
State TX
ZIP 78052
Phone 830 109-9960
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/29/2023
Certificate Expiration Date 10/28/2025
Facility Type Physician Office
Lab Director GLENDON S. HACK

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This page was last updated on: 9/29/2025