45D2069850 CLIA NUMBER - ALTUS LAKE JACKSON, LP

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Laboratory Demographics

CLIA Number: 45D2069850

Facility Name: ALTUS LAKE JACKSON, LP

Facility Address:
200 OAK DRIVE SOUTH
LAKE JACKSON, TX
ZIP 77566
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Facility Phone Number: 979 529-2000

Facility Type: Other - FREE STANDING ER

Certificate Type: Certificate of Compliance

NPI Number: 1275957508

Taxonomy: 261QE0002X - Clinic/Center

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
CertificateType	2
CertificateEffectiveDate	12/28/2023
CertificateExpirationDate	12/27/2025
FacilityType	Compliance

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