19D0921825 CLIA NUMBER - COUNTRY CLINIC

Laboratory Demographics

  • CLIA Code: 19D0921825
  • Facility Name: COUNTRY CLINIC
  • Facility Address: 314 CHRISTINE LANE
    SIMMESPORT, LA
    ZIP 71369
  • Facility Phone: 318 941-2057
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: STEVE KUPLESKY MD
  • NPI Number: 1609825892
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 19D0921825
LAB Type Physician Office
Facility Name COUNTRY CLINIC
Street 314 CHRISTINE LANE
City SIMMESPORT
State LA
ZIP 71369
Phone 318 941-2057
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Physician Office
Lab Director STEVE KUPLESKY MD

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