19D2242527 CLIA NUMBER - SPRING LAKE PRIMARY CARE CLINIC PPM TESTING

Laboratory Demographics

  • CLIA Code: 19D2242527
  • Facility Name: SPRING LAKE PRIMARY CARE CLINIC PPM TESTING
  • Facility Address: 8445 LINE AVE, ST 100
    SHREVEPORT, LA
    ZIP 71106
  • Facility Phone: 318 626-1224
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: CHARLES W. WEBB
  • NPI Number: 1457395493
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D2242527
LAB Type Community Clinic
Facility Name SPRING LAKE PRIMARY CARE CLINIC PPM TESTING
Street 8445 LINE AVE, ST 100
City SHREVEPORT
State LA
ZIP 71106
Phone 318 626-1224
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 11/9/2023
Certificate Expiration Date 11/8/2025
Facility Type Community Clinic
Lab Director CHARLES W. WEBB

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