19D2106966 CLIA NUMBER - CHRISTUS ADVANCED DIAGNOSTICS

Laboratory Demographics

CLIA Number: 19D2106966

Facility Name: CHRISTUS ADVANCED DIAGNOSTICS

Facility Address:
855 PIERREMONT RD, SUITE 105
SHREVEPORT, LA
ZIP 71106
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Facility Phone Number: 318 861-7413

Facility Type: Other - INDEPEN. DIAGN. TESTING

Certificate Type: Waiver

NPI Number: 1548656465

Taxonomy: 261QM1200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D2106966
LAB Type	Other - INDEPEN. DIAGN. TESTING
Facility Name	CHRISTUS ADVANCED DIAGNOSTICS
Street	855 PIERREMONT RD, SUITE 105
City	SHREVEPORT
State	LA
ZIP	71106
Phone	318 861-7413
CertificateType	4
CertificateEffectiveDate	1/4/2024
CertificateExpirationDate	1/3/2026
FacilityType	Waiver

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