25D0696177 CLIA NUMBER - SOUTHEAST MISSISSIPPI AIR AMBULANCE

Laboratory Demographics

  • CLIA Code: 25D0696177
  • Facility Name: SOUTHEAST MISSISSIPPI AIR AMBULANCE
  • Facility Address: P O BOX 17889
    HATTIESBURG, MS
    ZIP 39404
  • Facility Phone: 601 264-0175
  • Facility Type: Other
  • Facility Type: Waiver
  • Lab Director: WADE N. SPRUILL JR
  • NPI Number: 1861509895
  • Taxonomy: 3416A0800X - Ambulance

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CLIA Record

Field Name Field Value
CLIA Number 25D0696177
LAB Type Other
Facility Name SOUTHEAST MISSISSIPPI AIR AMBULANCE
Street P O BOX 17889
City HATTIESBURG
State MS
ZIP 39404
Phone 601 264-0175
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 Other
Lab Director WADE N. SPRUILL JR

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