19D2107593 CLIA NUMBER - GREEN CLINIC-LANDON SMITH, MD

Laboratory Demographics

  • CLIA Code: 19D2107593
  • Facility Name: GREEN CLINIC-LANDON SMITH, MD
  • Facility Address: 411 EAST VAUGHN, SUITE 103
    RUSTON, LA
    ZIP 71270
  • Facility Phone: 318 225-9414
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: LANDON C. SMITH
  • NPI Number: 1578021093
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D2107593
LAB Type Physician Office
Facility Name GREEN CLINIC-LANDON SMITH, MD
Street 411 EAST VAUGHN, SUITE 103
City RUSTON
State LA
ZIP 71270
Phone 318 225-9414
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/15/2024
Certificate Expiration Date 3/14/2026
Facility Type Physician Office
Lab Director LANDON C. SMITH

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