25D0666535 CLIA NUMBER - RENAL CARE GROUP TUPELO, LLC DBA FRESENIUS MEDCIAL CARE TUPELO

Laboratory Demographics

  • CLIA Code: 25D0666535
  • Facility Name: RENAL CARE GROUP TUPELO, LLC DBA FRESENIUS MEDCIAL CARE TUPELO
  • Facility Address: 2978 MATTOX ST
    TUPELO, MS
    ZIP 38801
  • Facility Phone: 662 844-0009
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. AMITA MAIBAM
  • NPI Number: 1205334513
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D0666535
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name RENAL CARE GROUP TUPELO, LLC DBA FRESENIUS MEDCIAL CARE TUPELO
Street 2978 MATTOX ST
City TUPELO
State MS
ZIP 38801
Phone 662 844-0009
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/4/2023
Certificate Expiration Date 11/3/2025
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. AMITA MAIBAM

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