25D1025940 CLIA NUMBER - BAPTIST-DESOTO SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 25D1025940
  • Facility Name: BAPTIST-DESOTO SURGERY CENTER
  • Facility Address: 391 SOUTHCREST CIRCLE SUITE 100
    SOUTHAVEN, MS
    ZIP 38671
  • Facility Phone: 662 349-0910
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: BRIAN SHWER
  • NPI Number: 1447225503
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D1025940
LAB Type Ambulatory Surgery Center
Facility Name BAPTIST-DESOTO SURGERY CENTER
Street 391 SOUTHCREST CIRCLE SUITE 100
City SOUTHAVEN
State MS
ZIP 38671
Phone 662 349-0910
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/8/2025
Certificate Expiration Date 7/7/2027
Facility Type Ambulatory Surgery Center
Lab Director BRIAN SHWER

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