19D1012403 CLIA NUMBER - MICHAEL RUSSO, MD

Laboratory Demographics

  • CLIA Code: 19D1012403
  • Facility Name: MICHAEL RUSSO, MD
  • Facility Address: 1111 MEDICAL CENTER BLVD
    MARRERO, LA
    ZIP 70072
  • Facility Phone: 504 367-8577
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL RUSSO, MD
  • NPI Number: 1194887125
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 19D1012403
LAB Type Physician Office
Facility Name MICHAEL RUSSO, MD
Street 1111 MEDICAL CENTER BLVD
City MARRERO
State LA
ZIP 70072
Phone 504 367-8577
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/9/2025
Certificate Expiration Date 5/8/2027
Facility Type Physician Office
Lab Director MICHAEL RUSSO, MD

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This page was last updated on: 6/4/2025