19D2109908 CLIA NUMBER - BEAUREGARD INTERNAL MEDICINE CENTER, LLC

Laboratory Demographics

CLIA Number: 19D2109908

Facility Name: BEAUREGARD INTERNAL MEDICINE CENTER, LLC

Facility Address:
495 W 8TH STREET
DERIDDER, LA
ZIP 70634
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Facility Phone Number: 337 462-2262

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1801261417

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D2109908
LAB Type	Rural Health Clinic
Facility Name	BEAUREGARD INTERNAL MEDICINE CENTER, LLC
Street	495 W 8TH STREET
City	DERIDDER
State	LA
ZIP	70634
Phone	337 462-2262
CertificateType	4
CertificateEffectiveDate	3/4/2024
CertificateExpirationDate	3/3/2026
FacilityType	Waiver

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