25D1020992 CLIA NUMBER - MEDICAL FOUNDATION INC RUSH MEDICAL GROUP UROLOGY

Laboratory Demographics

  • CLIA Code: 25D1020992
  • Facility Name: MEDICAL FOUNDATION INC RUSH MEDICAL GROUP UROLOGY
  • Facility Address: ATTENTION LANCE BRENT 1800 12TH STREET
    MERIDIAN, MS
    ZIP 39301
  • Facility Phone: 601 703-3018
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: STANLEY A. WADE
  • NPI Number: 1609820539
  • Taxonomy: 207Q00000X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 25D1020992
LAB Type Physician Office
Facility Name MEDICAL FOUNDATION INC RUSH MEDICAL GROUP UROLOGY
Street ATTENTION LANCE BRENT 1800 12TH STREET
City MERIDIAN
State MS
ZIP 39301
Phone 601 703-3018
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 1/9/2024
Certificate Expiration Date 1/8/2026
Facility Type Physician Office
Lab Director STANLEY A. WADE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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