19D1032483 CLIA NUMBER - DIALYSIS CLINIC INC NORTH SHREVEPORT

Laboratory Demographics

  • CLIA Code: 19D1032483
  • Facility Name: DIALYSIS CLINIC INC NORTH SHREVEPORT
  • Facility Address: 1515 NORTH HEARNE AVENUE
    SHREVEPORT, LA
    ZIP 71107
  • Facility Phone: 318 220-7012
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: CONSTANCE THOMAS
  • NPI Number: 1679592810
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D1032483
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name DIALYSIS CLINIC INC NORTH SHREVEPORT
Street 1515 NORTH HEARNE AVENUE
City SHREVEPORT
State LA
ZIP 71107
Phone 318 220-7012
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/25/2024
Certificate Expiration Date 10/24/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director CONSTANCE THOMAS

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