19D2124980 CLIA NUMBER - EDIE BOUDREAUX, LLC

Laboratory Demographics

CLIA Number: 19D2124980

Facility Name: EDIE BOUDREAUX, LLC

Facility Address:
124 E MAIN STREET, SUITE 104
NEW IBERIA, LA
ZIP 70560
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Facility Phone Number: 337 608-9922

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1457769358

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D2124980
LAB Type	Physician Office
Facility Name	EDIE BOUDREAUX, LLC
Street	124 E MAIN STREET, SUITE 104
City	NEW IBERIA
State	LA
ZIP	70560
Phone	337 608-9922
CertificateType	4
CertificateEffectiveDate	1/30/2023
CertificateExpirationDate	1/29/2025
FacilityType	Waiver

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