25D0680854 CLIA NUMBER - SOUTH CENTRAL UROLOGY CLINIC

Laboratory Demographics

  • CLIA Code: 25D0680854
  • Facility Name: SOUTH CENTRAL UROLOGY CLINIC
  • Facility Address: 1002 JEFFERSON STREET, SUITE 450
    LAUREL, MS
    ZIP 39440
  • Facility Phone: 601 428-0438
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JENS GRAVERSEN
  • NPI Number: 1275705824
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 25D0680854
LAB Type Physician Office
Facility Name SOUTH CENTRAL UROLOGY CLINIC
Street 1002 JEFFERSON STREET, SUITE 450
City LAUREL
State MS
ZIP 39440
Phone 601 428-0438
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director JENS GRAVERSEN

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