19D2284151 CLIA NUMBER - WELLNESS PASS LLC

Laboratory Demographics

CLIA Number: 19D2284151

Facility Name: WELLNESS PASS LLC

Facility Address:
1534 ELIZABETH AVE, SUITE 401
SHREVEPORT, LA
ZIP 71101
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Facility Phone Number: 318 431-8613

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1265138226

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	19D2284151
LAB Type	Physician Office
Facility Name	WELLNESS PASS LLC
Street	1534 ELIZABETH AVE, SUITE 401
City	SHREVEPORT
State	LA
ZIP	71101
Phone	318 431-8613
CertificateType	4
CertificateEffectiveDate	6/19/2023
CertificateExpirationDate	6/18/2025
FacilityType	Waiver

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