19D0723122 CLIA NUMBER - SHREVEPORT SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 19D0723122
  • Facility Name: SHREVEPORT SURGERY CENTER
  • Facility Address: 745 OLIVE STREET SUITE 100
    SHREVEPORT, LA
    ZIP 71104
  • Facility Phone: 318 227-1163
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: WADE H. ALLAIN
  • NPI Number: 1598804486
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D0723122
LAB Type Ambulatory Surgery Center
Facility Name SHREVEPORT SURGERY CENTER
Street 745 OLIVE STREET SUITE 100
City SHREVEPORT
State LA
ZIP 71104
Phone 318 227-1163
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Ambulatory Surgery Center
Lab Director WADE H. ALLAIN

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