19D2305545 CLIA NUMBER - OUR LADY OF THE LAKE ADVANCED DIAGNOSTICS

Laboratory Demographics

  • CLIA Code: 19D2305545
  • Facility Name: OUR LADY OF THE LAKE ADVANCED DIAGNOSTICS
  • Facility Address: 7777 HENNESSEY BLVD, MEDICAL PLAZA 1, SUITE 116
    BATON ROUGE, LA
    ZIP 70808
  • Facility Phone: 225 374-1824
  • Facility Type: Other - ADVANCED IMAGING CENTER
  • Facility Type: Waiver
  • Lab Director: BRANDON ST AMANT
  • NPI Number: 1851391148
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 19D2305545
LAB Type Other - ADVANCED IMAGING CENTER
Facility Name OUR LADY OF THE LAKE ADVANCED DIAGNOSTICS
Street 7777 HENNESSEY BLVD, MEDICAL PLAZA 1, SUITE 116
City BATON ROUGE
State LA
ZIP 70808
Phone 225 374-1824
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/3/2024
Certificate Expiration Date 6/2/2026
Facility Type Other - ADVANCED IMAGING CENTER
Lab Director BRANDON ST AMANT

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