19D2163654 CLIA NUMBER - CLARK INTEGRATED MEDICAL CLINICA

Laboratory Demographics

  • CLIA Code: 19D2163654
  • Facility Name: CLARK INTEGRATED MEDICAL CLINICA
  • Facility Address: 401 E VEROT SCHOOL RD
    LAFAYETTE, LA
    ZIP 70508
  • Facility Phone: 337 232-3353
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRAD BOUDREAUX
  • NPI Number: 1124529284
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 19D2163654
LAB Type Physician Office
Facility Name CLARK INTEGRATED MEDICAL CLINICA
Street 401 E VEROT SCHOOL RD
City LAFAYETTE
State LA
ZIP 70508
Phone 337 232-3353
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2025
Certificate Expiration Date 3/18/2027
Facility Type Physician Office
Lab Director BRAD BOUDREAUX

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