19D2069089 CLIA NUMBER - MONTGOMERY FAMILY CLINIC

Laboratory Demographics

  • CLIA Code: 19D2069089
  • Facility Name: MONTGOMERY FAMILY CLINIC
  • Facility Address: 641 ROWENA STREET
    MONTGOMERY, LA
    ZIP 71454
  • Facility Phone: 318 646-3000
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: ERIC C. DUPREE
  • NPI Number: 1730429952
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D2069089
LAB Type Rural Health Clinic
Facility Name MONTGOMERY FAMILY CLINIC
Street 641 ROWENA STREET
City MONTGOMERY
State LA
ZIP 71454
Phone 318 646-3000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2023
Certificate Expiration Date 11/17/2025
Facility Type Rural Health Clinic
Lab Director ERIC C. DUPREE

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