19D2179452 CLIA NUMBER - PARK PLAZA SURGICAL SPECIALISTS

Laboratory Demographics

  • CLIA Code: 19D2179452
  • Facility Name: PARK PLAZA SURGICAL SPECIALISTS
  • Facility Address: 8731 PARK PLAZA DR, SUITE B
    SHREVEPORT, LA
    ZIP 71105
  • Facility Phone: (318) 703-2643
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: RANDALL P. BREWER
  • NPI Number: 1346871605
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D2179452
LAB Type Ambulatory Surgery Center
Facility Name PARK PLAZA SURGICAL SPECIALISTS
Street 8731 PARK PLAZA DR, SUITE B
City SHREVEPORT
State LA
ZIP 71105
Phone 3187032643
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/24/2026
Certificate Expiration Date 2/23/2028
Facility Type Ambulatory Surgery Center
Lab Director RANDALL P. BREWER

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This page was last updated on: 5/18/2026