19D1099272 CLIA NUMBER - COMMUNITY CARE CLINIC

Laboratory Demographics

  • CLIA Code: 19D1099272
  • Facility Name: COMMUNITY CARE CLINIC
  • Facility Address: 122 PROFESSIONAL DRIVE
    WEST MONROE, LA
    ZIP 71291
  • Facility Phone: 318 397-3636
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: WAYNE RUTLEDGE
  • NPI Number: 1265671754
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D1099272
LAB Type Practitioner Other
Facility Name COMMUNITY CARE CLINIC
Street 122 PROFESSIONAL DRIVE
City WEST MONROE
State LA
ZIP 71291
Phone 318 397-3636
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/10/2025
Certificate Expiration Date 2/9/2027
Facility Type Practitioner Other
Lab Director WAYNE RUTLEDGE

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