25D0971993 CLIA NUMBER - MAE PHYSICIANS SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 25D0971993
  • Facility Name: MAE PHYSICIANS SURGERY CENTER
  • Facility Address: 1190 NORTH STATE STREET SUITE 102
    JACKSON, MS
    ZIP 39202
  • Facility Phone: 601 968-1790
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: CARLA M. GLAZE
  • NPI Number: 1033190129
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D0971993
LAB Type Ambulatory Surgery Center
Facility Name MAE PHYSICIANS SURGERY CENTER
Street 1190 NORTH STATE STREET SUITE 102
City JACKSON
State MS
ZIP 39202
Phone 601 968-1790
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/28/2024
Certificate Expiration Date 3/27/2026
Facility Type Ambulatory Surgery Center
Lab Director CARLA M. GLAZE

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