19D1045078 CLIA NUMBER - PHILADELPHIA CENTER,THE

Laboratory Demographics

  • CLIA Code: 19D1045078
  • Facility Name: PHILADELPHIA CENTER,THE
  • Facility Address: 2020 CENTENARY BLVD
    SHREVEPORT, LA
    ZIP 71104
  • Facility Phone: 318 222-6633
  • Facility Type: Other - COMM. BASED ORG
  • Facility Type: Waiver
  • Lab Director: CHRIS A. MICIOTTO
  • NPI Number: 1134348923
  • Taxonomy: 251B00000X - Case Management

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CLIA Record

Field Name Field Value
CLIA Number 19D1045078
LAB Type Other - COMM. BASED ORG
Facility Name PHILADELPHIA CENTER,THE
Street 2020 CENTENARY BLVD
City SHREVEPORT
State LA
ZIP 71104
Phone 318 222-6633
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/6/2025
Certificate Expiration Date 9/5/2027
Facility Type Other - COMM. BASED ORG
Lab Director CHRIS A. MICIOTTO

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