25D0316773 CLIA NUMBER - BOLIVAR PHYS PRACT DBA CLEVELAND MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 25D0316773
  • Facility Name: BOLIVAR PHYS PRACT DBA CLEVELAND MEDICAL CLINIC
  • Facility Address: 810 EAST SUNFLOWER ROAD STE 100-A
    CLEVELAND, MS
    ZIP 38732
  • Facility Phone: 662 843-3606
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. STEVEN CLARK
  • NPI Number: 1043454655
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 25D0316773
LAB Type Physician Office
Facility Name BOLIVAR PHYS PRACT DBA CLEVELAND MEDICAL CLINIC
Street 810 EAST SUNFLOWER ROAD STE 100-A
City CLEVELAND
State MS
ZIP 38732
Phone 662 843-3606
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 5/16/2025
Certificate Expiration Date 5/15/2027
Facility Type Physician Office
Lab Director DR. STEVEN CLARK

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