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19D1085535 CLIA NUMBER - GREENE FAMILY CLINIC AT KROTZ SPRINGS

Laboratory Demographics

CLIA Number: 19D1085535

Facility Name: GREENE FAMILY CLINIC AT KROTZ SPRINGS

Facility Address:
216 PARK STREET, STE A
KROTZ SPRINGS, LA
ZIP 70750
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Facility Phone Number: 337 566-2762

Facility Type: Rural Health Clinic

Certificate Type: Waiver
NPI Number: 1588336374

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name Field Value
CLIA Number 19D1085535
LAB Type Rural Health Clinic
Facility Name GREENE FAMILY CLINIC AT KROTZ SPRINGS
Street 216 PARK STREET, STE A
City KROTZ SPRINGS
State LA
ZIP 70750
Phone 337 566-2762
CertificateType 4
CertificateEffectiveDate 10/1/2023
CertificateExpirationDate 9/30/2025
FacilityType Waiver

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