19D0927607 CLIA NUMBER - EAST CARROLL MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 19D0927607

Facility Name: EAST CARROLL MEDICAL CLINIC

Facility Address:
340 N HOOD STREET
LAKE PROVIDENCE, LA
ZIP 71254
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Facility Phone Number: 318 559-2404

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1902885650

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D0927607
LAB Type	Community Clinic
Facility Name	EAST CARROLL MEDICAL CLINIC
Street	340 N HOOD STREET
City	LAKE PROVIDENCE
State	LA
ZIP	71254
Phone	318 559-2404
CertificateType	4
CertificateEffectiveDate	8/17/2023
CertificateExpirationDate	8/16/2025
FacilityType	Waiver

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