25D0953294 CLIA NUMBER - DELTA GASTROENTEROLOGY

Laboratory Demographics

  • CLIA Code: 25D0953294
  • Facility Name: DELTA GASTROENTEROLOGY
  • Facility Address: 9140 HWY 51 NORTH
    SOUTHAVEN, MS
    ZIP 38671
  • Facility Phone: 662 280-8222
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ULRIC D. DUNCAN
  • NPI Number: 1285789677
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 25D0953294
LAB Type Physician Office
Facility Name DELTA GASTROENTEROLOGY
Street 9140 HWY 51 NORTH
City SOUTHAVEN
State MS
ZIP 38671
Phone 662 280-8222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/31/2025
Certificate Expiration Date 1/30/2027
Facility Type Physician Office
Lab Director ULRIC D. DUNCAN

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