25D0320005 CLIA NUMBER - CENTREVILLE CLINIC

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Laboratory Demographics

CLIA Number: 25D0320005

Facility Name: CENTREVILLE CLINIC

Facility Address:
178 HWY 24 STE A
CENTREVILLE, MS
ZIP 39631
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Facility Phone Number: 601 890-0520

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1134166812

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D0320005
LAB Type	Physician Office
Facility Name	CENTREVILLE CLINIC
Street	178 HWY 24 STE A
City	CENTREVILLE
State	MS
ZIP	39631
Phone	601 890-0520
CertificateType	4
CertificateEffectiveDate	5/19/2023
CertificateExpirationDate	5/18/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024