19D0904433 CLIA NUMBER - THIBODAUX LASER & SURGERY CENTER LLC

Laboratory Demographics

CLIA Number: 19D0904433

Facility Name: THIBODAUX LASER & SURGERY CENTER LLC

Facility Address:
1101 AUDUBON AVENUE SUITE S4
THIBODAUX, LA
ZIP 70301
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Facility Phone Number: 985 447-7246

Facility Type: Ambulatory Surgery Center

Certificate Type: Waiver

NPI Number: 1073505616

Taxonomy: 261QA1903X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D0904433
LAB Type	Ambulatory Surgery Center
Facility Name	THIBODAUX LASER & SURGERY CENTER LLC
Street	1101 AUDUBON AVENUE SUITE S4
City	THIBODAUX
State	LA
ZIP	70301
Phone	985 447-7246
CertificateType	4
CertificateEffectiveDate	8/18/2023
CertificateExpirationDate	8/17/2025
FacilityType	Waiver

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