19D0972005 CLIA NUMBER - SOUTHERN UNIVERSITY STUDENT HEALTH SERVICES

Laboratory Demographics

  • CLIA Code: 19D0972005
  • Facility Name: SOUTHERN UNIVERSITY STUDENT HEALTH SERVICES
  • Facility Address: BARANCO-HILL BUILDING
    BATON ROUGE, LA
    ZIP 70813
  • Facility Phone: 225 771-4770
  • Facility Type: School/Student Health Service
  • Facility Type: Waiver
  • Lab Director: ALENCIA C. ELLIS
  • NPI Number: 1124174545
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 19D0972005
LAB Type School/Student Health Service
Facility Name SOUTHERN UNIVERSITY STUDENT HEALTH SERVICES
Street BARANCO-HILL BUILDING
City BATON ROUGE
State LA
ZIP 70813
Phone 225 771-4770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/15/2023
Certificate Expiration Date 5/14/2025
Facility Type School/Student Health Service
Lab Director ALENCIA C. ELLIS

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This page was last updated on: 3/20/2025