19D0987900 CLIA NUMBER - DIALYSIS CLINIC, INC EAST SHREVEPORT

Laboratory Demographics

  • CLIA Code: 19D0987900
  • Facility Name: DIALYSIS CLINIC, INC EAST SHREVEPORT
  • Facility Address: 102 ARDMORE AVENUE
    SHREVEPORT, LA
    ZIP 71105
  • Facility Phone: 318 861-5051
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MATTHEW J. OWENS
  • NPI Number: 1295768687
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D0987900
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name DIALYSIS CLINIC, INC EAST SHREVEPORT
Street 102 ARDMORE AVENUE
City SHREVEPORT
State LA
ZIP 71105
Phone 318 861-5051
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/15/2025
Certificate Expiration Date 6/14/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MATTHEW J. OWENS

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