19D2043646 CLIA NUMBER - PROGRESSIVE CHILDREN'S CLINIC LLC

Laboratory Demographics

  • CLIA Code: 19D2043646
  • Facility Name: PROGRESSIVE CHILDREN'S CLINIC LLC
  • Facility Address: 1919 FAIRFIELD AVENUE
    SHREVEPORT, LA
    ZIP 71101
  • Facility Phone: 318 828-2210
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMANDA B. KAMPERT
  • NPI Number: 1942573589
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 19D2043646
LAB Type Physician Office
Facility Name PROGRESSIVE CHILDREN'S CLINIC LLC
Street 1919 FAIRFIELD AVENUE
City SHREVEPORT
State LA
ZIP 71101
Phone 318 828-2210
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2024
Certificate Expiration Date 9/30/2026
Facility Type Physician Office
Lab Director AMANDA B. KAMPERT

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