19D2119405 CLIA NUMBER - SOUTHERN UROLOGY, LLC

Laboratory Demographics

  • CLIA Code: 19D2119405
  • Facility Name: SOUTHERN UROLOGY, LLC
  • Facility Address: 2308 EAST MAIN STREET, SUITE A
    NEW IBERIA, LA
    ZIP 70560
  • Facility Phone: 337 408-8676
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ANDRE P. BROUSSARD
  • NPI Number: 1104534965
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 19D2119405
LAB Type Physician Office
Facility Name SOUTHERN UROLOGY, LLC
Street 2308 EAST MAIN STREET, SUITE A
City NEW IBERIA
State LA
ZIP 70560
Phone 337 408-8676
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 9/27/2024
Certificate Expiration Date 9/26/2026
Facility Type Physician Office
Lab Director ANDRE P. BROUSSARD

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