19D0457991 CLIA NUMBER - ST PHILIP CLINIC

Laboratory Demographics

  • CLIA Code: 19D0457991
  • Facility Name: ST PHILIP CLINIC
  • Facility Address: 1108 ST JAMES ST
    VACHERIE, LA
    ZIP 70090
  • Facility Phone: 225 265-4087
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ROLAND S. WAGUESPACK MD
  • NPI Number: 1790906766
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D0457991
LAB Type Physician Office
Facility Name ST PHILIP CLINIC
Street 1108 ST JAMES ST
City VACHERIE
State LA
ZIP 70090
Phone 225 265-4087
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/2/2024
Certificate Expiration Date 8/1/2026
Facility Type Physician Office
Lab Director ROLAND S. WAGUESPACK MD

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