45D2069850 CLIA NUMBER - ALTUS LAKE JACKSON, LP

Laboratory Demographics

  • CLIA Code: 45D2069850
  • Facility Name: ALTUS LAKE JACKSON, LP
  • Facility Address: 200 OAK DRIVE SOUTH
    LAKE JACKSON, TX
    ZIP 77566
  • Facility Phone: 979 529-2000
  • Facility Type: Other - FREE STANDING ER
  • Facility Type: Certificate of Compliance
  • Lab Director: COREY H. ANDERSON
  • NPI Number: 1275957508
  • Taxonomy: 261QE0002X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2069850
LAB Type Other - FREE STANDING ER
Facility Name ALTUS LAKE JACKSON, LP
Street 200 OAK DRIVE SOUTH
City LAKE JACKSON
State TX
ZIP 77566
Phone 979 529-2000
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 12/28/2023
Certificate Expiration Date 12/27/2025
Facility Type Other - FREE STANDING ER
Lab Director COREY H. ANDERSON

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