19D0673062 CLIA NUMBER - PEDIATRIC ASSOCIATES

Laboratory Demographics

CLIA Number: 19D0673062

Facility Name: PEDIATRIC ASSOCIATES

Facility Address:
59325 RIVER WEST DR SUITE D
PLAQUEMINE, LA
ZIP 70764
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Facility Phone Number: 225 687-3055

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1639257215

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	19D0673062
LAB Type	Physician Office
Facility Name	PEDIATRIC ASSOCIATES
Street	59325 RIVER WEST DR SUITE D
City	PLAQUEMINE
State	LA
ZIP	70764
Phone	225 687-3055
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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