19D2161662 CLIA NUMBER - ANNA FONTENOT MEDICAL CENTR, LLC

Laboratory Demographics

CLIA Number: 19D2161662

Facility Name: ANNA FONTENOT MEDICAL CENTR, LLC

Facility Address:
1008 W MAIN STREET
VILLE PLATTE, LA
ZIP 70586
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Facility Phone Number: 337 363-5531

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1962716258

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	19D2161662
LAB Type	Physician Office
Facility Name	ANNA FONTENOT MEDICAL CENTR, LLC
Street	1008 W MAIN STREET
City	VILLE PLATTE
State	LA
ZIP	70586
Phone	337 363-5531
CertificateType	4
CertificateEffectiveDate	2/7/2023
CertificateExpirationDate	2/6/2025
FacilityType	Waiver

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