25D0674105 CLIA NUMBER - 627 MIDDLETON ROAD OPCO LLC

Laboratory Demographics

  • CLIA Code: 25D0674105
  • Facility Name: 627 MIDDLETON ROAD OPCO LLC
  • Facility Address: 627 MIDDLETON RD
    WINONA, MS
    ZIP 38967
  • Facility Phone: 662 283-1260
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: JONATHAN S. MATTHEWS
  • NPI Number: 1144267709
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 25D0674105
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name 627 MIDDLETON ROAD OPCO LLC
Street 627 MIDDLETON RD
City WINONA
State MS
ZIP 38967
Phone 662 283-1260
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director JONATHAN S. MATTHEWS

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