19D2025672 CLIA NUMBER - BASTROP OUTPATIENT RURAL HEALTH CLINIC

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Laboratory Demographics

CLIA Number: 19D2025672

Facility Name: BASTROP OUTPATIENT RURAL HEALTH CLINIC

Facility Address:
370 WEST HICKORY
BASTROP, LA
ZIP 71220
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Facility Phone Number: 318 665-9950

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1669658571

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D2025672
LAB Type	Rural Health Clinic
Facility Name	BASTROP OUTPATIENT RURAL HEALTH CLINIC
Street	370 WEST HICKORY
City	BASTROP
State	LA
ZIP	71220
Phone	318 665-9950
CertificateType	4
CertificateEffectiveDate	6/15/2023
CertificateExpirationDate	6/14/2025
FacilityType	Waiver

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