19D2303795 CLIA NUMBER - BHG LXII, LLC MEDICAL SERVICES LOUISIANA

Laboratory Demographics

  • CLIA Code: 19D2303795
  • Facility Name: BHG LXII, LLC MEDICAL SERVICES LOUISIANA
  • Facility Address: 1303 LINE AVENUE, SUITE #600, OBOT ROOM #100
    SHREVEPORT, LA
    ZIP 71101
  • Facility Phone: (318) 425-3400
  • Facility Type: Other - OFFICE BASED OPIOD
  • Facility Type: Waiver
  • Lab Director: KELLEY TAYLOR
  • NPI Number: 1134838857
  • Taxonomy: 261QR0405X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 19D2303795
LAB Type Other - OFFICE BASED OPIOD
Facility Name BHG LXII, LLC MEDICAL SERVICES LOUISIANA
Street 1303 LINE AVENUE, SUITE #600, OBOT ROOM #100
City SHREVEPORT
State LA
ZIP 71101
Phone 3184253400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/1/2026
Certificate Expiration Date 4/30/2028
Facility Type Other - OFFICE BASED OPIOD
Lab Director KELLEY TAYLOR

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This page was last updated on: 5/18/2026