25D0030098 CLIA NUMBER - ELLISVILLE STATE SCHOOL

Laboratory Demographics

  • CLIA Code: 25D0030098
  • Facility Name: ELLISVILLE STATE SCHOOL
  • Facility Address: 1101 HIGHWAY 11 SOUTH
    ELLISVILLE, MS
    ZIP 39437
  • Facility Phone: 601 477-9384
  • Facility Type: Intermediate Care Facility for Mentally Retarded
  • Facility Type: Waiver
  • Lab Director: DR. JOSEPH MORING
  • NPI Number: 1013085414
  • Taxonomy: 122300000X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 25D0030098
LAB Type Intermediate Care Facility for Mentally Retarded
Facility Name ELLISVILLE STATE SCHOOL
Street 1101 HIGHWAY 11 SOUTH
City ELLISVILLE
State MS
ZIP 39437
Phone 601 477-9384
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/7/2024
Certificate Expiration Date 5/6/2026
Facility Type Intermediate Care Facility for Mentally Retarded
Lab Director DR. JOSEPH MORING

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