25D0958305 CLIA NUMBER - NORTH MISSISSIPPI STATE HOSPITAL

Laboratory Demographics

CLIA Number: 25D0958305

Facility Name: NORTH MISSISSIPPI STATE HOSPITAL

Facility Address:
1937 BRIAR RIDGE ROAD
TUPELO, MS
ZIP 38804
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Facility Phone Number: 662 690-4307

Facility Type: Hospital

Certificate Type: Waiver

NPI Number: 1760832638

Taxonomy: 3416L0300X - Ambulance

CLIA Record

Field Name	Field Value
CLIA Number	25D0958305
LAB Type	Hospital
Facility Name	NORTH MISSISSIPPI STATE HOSPITAL
Street	1937 BRIAR RIDGE ROAD
City	TUPELO
State	MS
ZIP	38804
Phone	662 690-4307
CertificateType	4
CertificateEffectiveDate	3/16/2023
CertificateExpirationDate	3/15/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024