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

Laboratory Demographics

CLIA Number: 19D2242527

Facility Name: SPRING LAKE PRIMARY CARE CLINIC PPM TESTING

Facility Address:
8445 LINE AVE, ST 100
SHREVEPORT, LA
ZIP 71106
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Facility Phone Number: 318 626-4242

Facility Type: Community Clinic

Certificate Type: Microscopy
NPI Number: 1457395493

Taxonomy: 261QA1903X - Clinic/Center

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 318 626-4242
CertificateType 3
CertificateEffectiveDate 11/9/2023
CertificateExpirationDate 11/8/2025
FacilityType PPMP

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