19D2002299 CLIA NUMBER - COMMUNITY BASED OUTPATIENT CLINIC BOGALUSA

Laboratory Demographics

  • CLIA Code: 19D2002299
  • Facility Name: COMMUNITY BASED OUTPATIENT CLINIC BOGALUSA
  • Facility Address: 521 ONTARIO AVENUE
    BOGALUSA, LA
    ZIP 70427
  • Facility Phone: 985 735-9029
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOSEPH TUSA
  • NPI Number: 1174797393
  • Taxonomy: 3747P1801X - Technician

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CLIA Record

Field Name Field Value
CLIA Number 19D2002299
LAB Type Physician Office
Facility Name COMMUNITY BASED OUTPATIENT CLINIC BOGALUSA
Street 521 ONTARIO AVENUE
City BOGALUSA
State LA
ZIP 70427
Phone 985 735-9029
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/13/2024
Certificate Expiration Date 1/12/2026
Facility Type Physician Office
Lab Director JOSEPH TUSA

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