19D0907751 CLIA NUMBER - GASTROENTEROLOGY & NUTRITIONAL MEDICAL SERVICES, INC

Laboratory Demographics

CLIA Number: 19D0907751

Facility Name: GASTROENTEROLOGY & NUTRITIONAL MEDICAL SERVICES, INC

Facility Address:
616 SOUTH WASHINGTON STREET
BASTROP, LA
ZIP 71220
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Facility Phone Number: 318 283-2177

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1427018852

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	19D0907751
LAB Type	Physician Office
Facility Name	GASTROENTEROLOGY & NUTRITIONAL MEDICAL SERVICES, INC
Street	616 SOUTH WASHINGTON STREET
City	BASTROP
State	LA
ZIP	71220
Phone	318 283-2177
CertificateType	4
CertificateEffectiveDate	10/20/2023
CertificateExpirationDate	10/19/2025
FacilityType	Waiver

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