19D0860434 CLIA NUMBER - CHILDREN'S PEDIATRIC - BAYOU

Laboratory Demographics

  • CLIA Code: 19D0860434
  • Facility Name: CHILDREN'S PEDIATRIC - BAYOU
  • Facility Address: 569 ENTERPRISE DR
    HOUMA, LA
    ZIP 70360
  • Facility Phone: 985 872-6405
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MATTHEW W. STARK
  • NPI Number: 1003451188
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D0860434
LAB Type Physician Office
Facility Name CHILDREN'S PEDIATRIC - BAYOU
Street 569 ENTERPRISE DR
City HOUMA
State LA
ZIP 70360
Phone 985 872-6405
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 Physician Office
Lab Director MATTHEW W. STARK

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