25D0691798 CLIA NUMBER - CHILDREN'S INTERNATIONAL MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 25D0691798
  • Facility Name: CHILDREN'S INTERNATIONAL MEDICAL GROUP
  • Facility Address: 618 BLUE MEADOW RD
    BAY SAINT LOUIS, MS
    ZIP 39520
  • Facility Phone: 228 467-1320
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EDUARDO J. HERNANDEZ
  • NPI Number: 1336680529
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D0691798
LAB Type Physician Office
Facility Name CHILDREN'S INTERNATIONAL MEDICAL GROUP
Street 618 BLUE MEADOW RD
City BAY SAINT LOUIS
State MS
ZIP 39520
Phone 228 467-1320
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 Physician Office
Lab Director EDUARDO J. HERNANDEZ

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