19D1094962 CLIA NUMBER - JCT MEDICAL CONSULTING

Laboratory Demographics

  • CLIA Code: 19D1094962
  • Facility Name: JCT MEDICAL CONSULTING
  • Facility Address: 460 AHSLEY RIDGE BOULEVARD 500
    SHREVEPORT, LA
    ZIP 71106
  • Facility Phone: 318 820-8078
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RUSSELL W. TYNES MD
  • NPI Number: 1205022647
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D1094962
LAB Type Physician Office
Facility Name JCT MEDICAL CONSULTING
Street 460 AHSLEY RIDGE BOULEVARD 500
City SHREVEPORT
State LA
ZIP 71106
Phone 318 820-8078
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/30/2025
Certificate Expiration Date 1/29/2027
Facility Type Physician Office
Lab Director RUSSELL W. TYNES MD

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