19D0705206 CLIA NUMBER - PEDIATRIC MEDICAL CLINIC INC

Laboratory Demographics

CLIA Number: 19D0705206

Facility Name: PEDIATRIC MEDICAL CLINIC INC

Facility Address:
501 RUE DE SANTE, SUITE 9
LAPLACE, LA
ZIP 70068
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Facility Phone Number: 504 651-7444

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1043376007

Taxonomy: 2080A0000X - Pediatrics
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.

CLIA Record

Field Name	Field Value
CLIA Number	19D0705206
LAB Type	Physician Office
Facility Name	PEDIATRIC MEDICAL CLINIC INC
Street	501 RUE DE SANTE, SUITE 9
City	LAPLACE
State	LA
ZIP	70068
Phone	504 651-7444
CertificateType	4
CertificateEffectiveDate	3/1/2023
CertificateExpirationDate	2/28/2025
FacilityType	Waiver

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