19D2284773 CLIA NUMBER - DAVIS FAMILY HEALTHCARE LLC

Laboratory Demographics

CLIA Number: 19D2284773

Facility Name: DAVIS FAMILY HEALTHCARE LLC

Facility Address:
913 S COLLEGE ROAD, SUITE 216B
LAFAYETTE, LA
ZIP 70503
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Facility Phone Number: 337 915-8180

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1871208744

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	19D2284773
LAB Type	Practitioner Other
Facility Name	DAVIS FAMILY HEALTHCARE LLC
Street	913 S COLLEGE ROAD, SUITE 216B
City	LAFAYETTE
State	LA
ZIP	70503
Phone	337 915-8180
CertificateType	4
CertificateEffectiveDate	6/28/2023
CertificateExpirationDate	6/27/2025
FacilityType	Waiver

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