45D2010097 CLIA NUMBER - JACKSONVILLE HOSPITAL, LLC

Laboratory Demographics

  • CLIA Code: 45D2010097
  • Facility Name: JACKSONVILLE HOSPITAL, LLC
  • Facility Address: 1325 NORTH DICKINSON
    RUSK, TX
    ZIP 75785
  • Facility Phone: 903 541-5396
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: TODD S. HENDRICKSON
  • NPI Number: 1770082299
  • Taxonomy: 261QR1300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 45D2010097
LAB Type Rural Health Clinic
Facility Name JACKSONVILLE HOSPITAL, LLC
Street 1325 NORTH DICKINSON
City RUSK
State TX
ZIP 75785
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 7/20/2024
Certificate Expiration Date 7/19/2026
Facility Type Rural Health Clinic
Lab Director TODD S. HENDRICKSON

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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