19D2039771 CLIA NUMBER - SPINE CARE MEDICAL GROUP INC

Laboratory Demographics

  • CLIA Code: 19D2039771
  • Facility Name: SPINE CARE MEDICAL GROUP INC
  • Facility Address: 3939 HOUMA BLVD, SUITE 18
    METAIRIE, LA
    ZIP 70006
  • Facility Phone: 504 392-7123
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ALEXIS M. WAGUESPACK
  • NPI Number: 1467540179
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 19D2039771
LAB Type Physician Office
Facility Name SPINE CARE MEDICAL GROUP INC
Street 3939 HOUMA BLVD, SUITE 18
City METAIRIE
State LA
ZIP 70006
Phone 504 392-7123
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/17/2024
Certificate Expiration Date 4/16/2026
Facility Type Physician Office
Lab Director ALEXIS M. WAGUESPACK

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