45D2010097 CLIA NUMBER - JACKSONVILLE HOSPITAL, LLC

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Laboratory Demographics

CLIA Number: 45D2010097

Facility Name: JACKSONVILLE HOSPITAL, LLC

Facility Address:
1325 NORTH DICKINSON
RUSK, TX
ZIP 75785
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Facility Phone Number: 903 541-5396

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1770082299

Taxonomy: 261QR1300X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	7/20/2022
CertificateExpirationDate	7/19/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024