19D1096695 CLIA NUMBER - COASTAL URGENT CARE LLC

Laboratory Demographics

CLIA Number: 19D1096695

Facility Name: COASTAL URGENT CARE LLC

Facility Address:
1124 S BURNSIDE AVENUE SUITE A100
GONZALES, LA
ZIP 70737
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Facility Phone Number: 225 644-5503

Facility Type: Other - URGENT CARE

Certificate Type: Waiver

NPI Number: 1568601425

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D1096695
LAB Type	Other - URGENT CARE
Facility Name	COASTAL URGENT CARE LLC
Street	1124 S BURNSIDE AVENUE SUITE A100
City	GONZALES
State	LA
ZIP	70737
Phone	225 644-5503
CertificateType	4
CertificateEffectiveDate	3/10/2023
CertificateExpirationDate	3/9/2025
FacilityType	Waiver

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