19D2130175 CLIA NUMBER - MGH PHYSICIANS CLINIC

Laboratory Demographics

CLIA Number: 19D2130175

Facility Name: MGH PHYSICIANS CLINIC

Facility Address:
425 S VINE ST
BASTROP, LA
ZIP 71220
Get Directions

Facility Phone Number: 318 261-8705

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1891013496

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D2130175
LAB Type	Physician Office
Facility Name	MGH PHYSICIANS CLINIC
Street	425 S VINE ST
City	BASTROP
State	LA
ZIP	71220
Phone	318 261-8705
CertificateType	4
CertificateEffectiveDate	5/3/2023
CertificateExpirationDate	5/2/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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