19D0990237 CLIA NUMBER - WK UROLOGY CLINIC SOUTH

Laboratory Demographics

  • CLIA Code: 19D0990237
  • Facility Name: WK UROLOGY CLINIC SOUTH
  • Facility Address: 2508 BERT KOUNS, SUITE 200
    SHREVEPORT, LA
    ZIP 71118
  • Facility Phone: 318 212-5063
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JOHN A. MATA
  • NPI Number: 1881484186
  • Taxonomy: 208800000X - Urology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 19D0990237
LAB Type Physician Office
Facility Name WK UROLOGY CLINIC SOUTH
Street 2508 BERT KOUNS, SUITE 200
City SHREVEPORT
State LA
ZIP 71118
Phone 318 212-5063
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 8/17/2025
Certificate Expiration Date 8/16/2027
Facility Type Physician Office
Lab Director JOHN A. MATA

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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