19D2066625 CLIA NUMBER - CRESCENT CITY HEADACHE AND NEUROLOGY CENTER, LLC

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Laboratory Demographics

CLIA Number: 19D2066625

Facility Name: CRESCENT CITY HEADACHE AND NEUROLOGY CENTER, LLC

Facility Address:
2116 PAKENHAM DRIVE
CHALMETTE, LA
ZIP 70043
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Facility Phone Number: 504 301-1468

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1518409663

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	19D2066625
LAB Type	Physician Office
Facility Name	CRESCENT CITY HEADACHE AND NEUROLOGY CENTER, LLC
Street	2116 PAKENHAM DRIVE
City	CHALMETTE
State	LA
ZIP	70043
Phone	504 301-1468
CertificateType	4
CertificateEffectiveDate	7/29/2022
CertificateExpirationDate	7/28/2024
FacilityType	Waiver

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