19D1001042 CLIA NUMBER - PATRICIA A JACKSON, MD

Laboratory Demographics

  • CLIA Code: 19D1001042
  • Facility Name: PATRICIA A JACKSON, MD
  • Facility Address: 1111 MEDICAL CENTER BOULEVARD SUITE NORTH 408
    MARRERO, LA
    ZIP 70072
  • Facility Phone: (504) 349-2908
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: PATRICIA A. JACKSON, MD
  • NPI Number: 1326146036
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 19D1001042
LAB Type Physician Office
Facility Name PATRICIA A JACKSON, MD
Street 1111 MEDICAL CENTER BOULEVARD SUITE NORTH 408
City MARRERO
State LA
ZIP 70072
Phone 5043492908
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 6/28/2024
Certificate Expiration Date 6/27/2026
Facility Type Physician Office
Lab Director PATRICIA A. JACKSON, MD

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This page was last updated on: 5/18/2026