45D2240807 CLIA NUMBER - NICKSTER LLC

Laboratory Demographics

  • CLIA Code: 45D2240807
  • Facility Name: NICKSTER LLC
  • Facility Address: 1514 AUSTIN AVE
    WACO, TX
    ZIP 76701
  • Facility Phone: 254 772-8660
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: BRENT WILSON
  • NPI Number: 1164178984
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 45D2240807
LAB Type Home Health Agency
Facility Name NICKSTER LLC
Street 1514 AUSTIN AVE
City WACO
State TX
ZIP 76701
Phone 254 772-8660
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/22/2023
Certificate Expiration Date 10/21/2025
Facility Type Home Health Agency
Lab Director BRENT WILSON

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