19D2232638 CLIA NUMBER - CASTING CARE CLINIC

Laboratory Demographics

CLIA Number: 19D2232638

Facility Name: CASTING CARE CLINIC

Facility Address:
7840 JEWELLA AVE
SHREVEPORT, LA
ZIP 71108
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Facility Phone Number: 318 401-1432

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1295492999

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	19D2232638
LAB Type	Practitioner Other
Facility Name	CASTING CARE CLINIC
Street	7840 JEWELLA AVE
City	SHREVEPORT
State	LA
ZIP	71108
Phone	318 401-1432
CertificateType	4
CertificateEffectiveDate	8/16/2023
CertificateExpirationDate	8/15/2025
FacilityType	Waiver

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