19D2189603 CLIA NUMBER - IMPERIAL HEALTH DERIDDER PRIMARY CARE CLINIC

Laboratory Demographics

  • CLIA Code: 19D2189603
  • Facility Name: IMPERIAL HEALTH DERIDDER PRIMARY CARE CLINIC
  • Facility Address: 501 SHIRLEY STREET
    DERIDDER, LA
    ZIP 70634
  • Facility Phone: 337 202-7850
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JASON MORRIS
  • NPI Number: 1881083608
  • Taxonomy: 207RI0011X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 19D2189603
LAB Type Physician Office
Facility Name IMPERIAL HEALTH DERIDDER PRIMARY CARE CLINIC
Street 501 SHIRLEY STREET
City DERIDDER
State LA
ZIP 70634
Phone 337 202-7850
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/4/2024
Certificate Expiration Date 8/3/2026
Facility Type Physician Office
Lab Director JASON MORRIS

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