19D0969090 CLIA NUMBER - BOSSIER FAMILY MEDICINE, LLC

Laboratory Demographics

CLIA Number: 19D0969090

Facility Name: BOSSIER FAMILY MEDICINE, LLC

Facility Address:
2539 VIKING DRIVE SUITE 101
BOSSIER CITY, LA
ZIP 71111
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Facility Phone Number: 318 848-2930

Facility Type: Physician Office

Certificate Type: Accreditation

NPI Number: 1033572672

Taxonomy: 101YP2500X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	19D0969090
LAB Type	Physician Office
Facility Name	BOSSIER FAMILY MEDICINE, LLC
Street	2539 VIKING DRIVE SUITE 101
City	BOSSIER CITY
State	LA
ZIP	71111
Phone	318 848-2930
CertificateType	1
CertificateEffectiveDate	10/27/2022
CertificateExpirationDate	10/26/2024
FacilityType	Accreditation

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