19D0920560 CLIA NUMBER - EAST JEFFERSON FAMILY PRACTICE CENTER

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Laboratory Demographics

CLIA Number: 19D0920560

Facility Name: EAST JEFFERSON FAMILY PRACTICE CENTER

Facility Address:
4228 HOUMA BLVD, SUITE 200
METAIRIE, LA
ZIP 70006
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Facility Phone Number: 504 503-5057

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1053859082

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D0920560
LAB Type	Physician Office
Facility Name	EAST JEFFERSON FAMILY PRACTICE CENTER
Street	4228 HOUMA BLVD, SUITE 200
City	METAIRIE
State	LA
ZIP	70006
Phone	504 503-5057
CertificateType	3
CertificateEffectiveDate	10/3/2022
CertificateExpirationDate	10/2/2024
FacilityType	PPMP

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