25D0972439 CLIA NUMBER - COASTAL FAMILY HEALTH CTR-LEAKESVILLE ELEMENTARY

Laboratory Demographics

CLIA Number: 25D0972439

Facility Name: COASTAL FAMILY HEALTH CTR-LEAKESVILLE ELEMENTARY

Facility Address:
175 ANNEX ROAD
LEAKESVILLE, MS
ZIP 39451
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Facility Phone Number: 601 394-5093

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1700979960

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D0972439
LAB Type	School/Student Health Service
Facility Name	COASTAL FAMILY HEALTH CTR-LEAKESVILLE ELEMENTARY
Street	175 ANNEX ROAD
City	LEAKESVILLE
State	MS
ZIP	39451
Phone	601 394-5093
CertificateType	4
CertificateEffectiveDate	4/7/2024
CertificateExpirationDate	4/6/2026
FacilityType	Waiver

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