25D0957040 CLIA NUMBER - ELLISVILLE MEDICAL/OBGYN CLINIC LAB

Laboratory Demographics

  • CLIA Code: 25D0957040
  • Facility Name: ELLISVILLE MEDICAL/OBGYN CLINIC LAB
  • Facility Address: 1203 B AVENUE
    ELLISVILLE, MS
    ZIP 39437
  • Facility Phone: 601 477-2226
  • Facility Type: Other
  • Facility Type: Certificate of Compliance
  • Lab Director: AMANDA D. FLEMING
  • NPI Number: 1528498532
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 25D0957040
LAB Type Other
Facility Name ELLISVILLE MEDICAL/OBGYN CLINIC LAB
Street 1203 B AVENUE
City ELLISVILLE
State MS
ZIP 39437
Phone 601 477-2226
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 10/21/2024
Certificate Expiration Date 10/20/2026
Facility Type Other
Lab Director AMANDA D. FLEMING

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