19D2104428 CLIA NUMBER - ADVANCED CARDIOVASCULAR SPECIALISTS, LLC

Laboratory Demographics

  • CLIA Code: 19D2104428
  • Facility Name: ADVANCED CARDIOVASCULAR SPECIALISTS, LLC
  • Facility Address: 1453 E BERT KOUNS STE 112
    SHREVEPORT, LA
    ZIP 71105
  • Facility Phone: 318 798-9400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RALPH W. BAUCUM
  • NPI Number: 1881127090
  • Taxonomy: 207RC0000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 19D2104428
LAB Type Physician Office
Facility Name ADVANCED CARDIOVASCULAR SPECIALISTS, LLC
Street 1453 E BERT KOUNS STE 112
City SHREVEPORT
State LA
ZIP 71105
Phone 318 798-9400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2023
Certificate Expiration Date 11/3/2025
Facility Type Physician Office
Lab Director RALPH W. BAUCUM

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