45D1095752 CLIA NUMBER - JACKSONVILLE HOSPITAL, LLC

Laboratory Demographics

  • CLIA Code: 45D1095752
  • Facility Name: JACKSONVILLE HOSPITAL, LLC
  • Facility Address: 203 NACOGDOCHES SUITE 280 ATTN LABORATORY - SUSAN CAMPBELL
    JACKSONVILLE, TX
    ZIP 75766
  • Facility Phone: 903 541-5396
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SARAH TYNER
  • NPI Number: 1861991226
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D1095752
LAB Type Physician Office
Facility Name JACKSONVILLE HOSPITAL, LLC
Street 203 NACOGDOCHES SUITE 280 ATTN LABORATORY - SUSAN CAMPBELL
City JACKSONVILLE
State TX
ZIP 75766
Phone 903 541-5396
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/31/2024
Certificate Expiration Date 10/30/2026
Facility Type Physician Office
Lab Director SARAH TYNER

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