45D1059389 CLIA NUMBER - GRACE AMBULATORY SURGERY CENTER LP

Laboratory Demographics

  • CLIA Code: 45D1059389
  • Facility Name: GRACE AMBULATORY SURGERY CENTER LP
  • Facility Address: 4515 MARSHA SHARP FREEWAY
    LUBBOCK, TX
    ZIP 79407
  • Facility Phone: 806 740-8223
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: RANDALL S. HICKLE MD
  • NPI Number: 1083645006
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D1059389
LAB Type Ambulatory Surgery Center
Facility Name GRACE AMBULATORY SURGERY CENTER LP
Street 4515 MARSHA SHARP FREEWAY
City LUBBOCK
State TX
ZIP 79407
Phone 806 740-8223
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/28/2024
Certificate Expiration Date 9/27/2026
Facility Type Ambulatory Surgery Center
Lab Director RANDALL S. HICKLE MD

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