19D0976386 CLIA NUMBER - PORT BARRE FAMILY CLINIC

Laboratory Demographics

  • CLIA Code: 19D0976386
  • Facility Name: PORT BARRE FAMILY CLINIC
  • Facility Address: 17695 HIGHWAY 190
    PORT BARRE, LA
    ZIP 70577
  • Facility Phone: 337 585-7899
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: FREDDIE J. FANDAL, MD
  • NPI Number: 1053944512
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D0976386
LAB Type Physician Office
Facility Name PORT BARRE FAMILY CLINIC
Street 17695 HIGHWAY 190
City PORT BARRE
State LA
ZIP 70577
Phone 337 585-7899
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 8/2/2024
Certificate Expiration Date 8/1/2026
Facility Type Physician Office
Lab Director FREDDIE J. FANDAL, MD

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