25D0665358 CLIA NUMBER - BMA JACKSON

Laboratory Demographics

CLIA Number: 25D0665358

Facility Name: BMA JACKSON

Facility Address:
381 MEDICAL DR
JACKSON, MS
ZIP 39216
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Facility Phone Number: 601 981-9652

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1235241084

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D0665358
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	BMA JACKSON
Street	381 MEDICAL DR
City	JACKSON
State	MS
ZIP	39216
Phone	601 981-9652
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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