19D0992532 CLIA NUMBER - INGRAM MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 19D0992532

Facility Name: INGRAM MEDICAL CLINIC

Facility Address:
114 EAST FIFTH STREET
NATCHITOCHES, LA
ZIP 71457
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Facility Phone Number: 318 354-9348

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1336139799

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	19D0992532
LAB Type	Physician Office
Facility Name	INGRAM MEDICAL CLINIC
Street	114 EAST FIFTH STREET
City	NATCHITOCHES
State	LA
ZIP	71457
Phone	318 354-9348
CertificateType	4
CertificateEffectiveDate	10/18/2023
CertificateExpirationDate	10/17/2025
FacilityType	Waiver

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