45D2249201 CLIA NUMBER - CAREATC-VISTRA MARTIN LAKE

Laboratory Demographics

  • CLIA Code: 45D2249201
  • Facility Name: CAREATC-VISTRA MARTIN LAKE
  • Facility Address: 8850 FM 2658
    TATUM, TX
    ZIP 75691
  • Facility Phone: 918 779-7471
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AUSTIN DAVIDSON
  • NPI Number: 1285443002
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2249201
LAB Type Pharmacy
Facility Name CAREATC-VISTRA MARTIN LAKE
Street 8850 FM 2658
City TATUM
State TX
ZIP 75691
Phone 918 779-7471
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/19/2024
Certificate Expiration Date 1/18/2026
Facility Type Pharmacy
Lab Director AUSTIN DAVIDSON

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