19D2021036 CLIA NUMBER - MARK C MOUTON MD LLC

Laboratory Demographics

  • CLIA Code: 19D2021036
  • Facility Name: MARK C MOUTON MD LLC
  • Facility Address: 12902 PLANK RD
    BAKER, LA
    ZIP 70714
  • Facility Phone: 225 774-7111
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SUZANNE LOCKHART
  • NPI Number: 1164613758
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 19D2021036
LAB Type Physician Office
Facility Name MARK C MOUTON MD LLC
Street 12902 PLANK RD
City BAKER
State LA
ZIP 70714
Phone 225 774-7111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/4/2025
Certificate Expiration Date 3/3/2027
Facility Type Physician Office
Lab Director SUZANNE LOCKHART

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