19D2048779 CLIA NUMBER - LOURDES AFTER HOURS - BREAUX BRIDGE

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Laboratory Demographics

CLIA Number: 19D2048779

Facility Name: LOURDES AFTER HOURS - BREAUX BRIDGE

Facility Address:
1821 REES STREET
BREAUX BRIDGE, LA
ZIP 70517
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Facility Phone Number: 225 214-9352

Facility Type: Other - URGENT CARE WALKIN CLINIC

Certificate Type: Waiver

NPI Number: 1649297730

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D2048779
LAB Type	Other - URGENT CARE WALKIN CLINIC
Facility Name	LOURDES AFTER HOURS - BREAUX BRIDGE
Street	1821 REES STREET
City	BREAUX BRIDGE
State	LA
ZIP	70517
Phone	225 214-9352
CertificateType	4
CertificateEffectiveDate	10/23/2022
CertificateExpirationDate	10/22/2024
FacilityType	Waiver

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