19D2175182 CLIA NUMBER - THIBODEAUX MEDICAL CLINIC, LLC

Laboratory Demographics

  • CLIA Code: 19D2175182
  • Facility Name: THIBODEAUX MEDICAL CLINIC, LLC
  • Facility Address: 1303 HORRIDGE STREET
    VINTON, LA
    ZIP 70668
  • Facility Phone: 337 739-3134
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DERRICK F. THIBODEAUX
  • NPI Number: 1689224321
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 19D2175182
LAB Type Practitioner Other
Facility Name THIBODEAUX MEDICAL CLINIC, LLC
Street 1303 HORRIDGE STREET
City VINTON
State LA
ZIP 70668
Phone 337 739-3134
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/18/2023
Certificate Expiration Date 11/17/2025
Facility Type Practitioner Other
Lab Director DERRICK F. THIBODEAUX

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