19D2274176 CLIA NUMBER - GULF COAST NEPHROLOGY, LLC

Laboratory Demographics

  • CLIA Code: 19D2274176
  • Facility Name: GULF COAST NEPHROLOGY, LLC
  • Facility Address: 300 18TH ST, SUITE 200
    LAKE CHARLES, LA
    ZIP 70601
  • Facility Phone: 337 497-0366
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RODERICK V. CLARK
  • NPI Number: 1982340774
  • Taxonomy: 207RN0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 19D2274176
LAB Type Physician Office
Facility Name GULF COAST NEPHROLOGY, LLC
Street 300 18TH ST, SUITE 200
City LAKE CHARLES
State LA
ZIP 70601
Phone 337 497-0366
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/28/2024
Certificate Expiration Date 12/27/2026
Facility Type Physician Office
Lab Director RODERICK V. CLARK

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