25D1032113 CLIA NUMBER - JACKSON STATE UNIVERSITY-COMMUNITY HEALTH PROGRAM

Laboratory Demographics

  • CLIA Code: 25D1032113
  • Facility Name: JACKSON STATE UNIVERSITY-COMMUNITY HEALTH PROGRAM
  • Facility Address: 1400 LYNCH ST--LIBERAL ARTS BLDG, RM 124
    JACKSON, MS
    ZIP 39217
  • Facility Phone: 601 979-1551
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: KAYE F. SLY
  • NPI Number: 1366991523
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 25D1032113
LAB Type Community Clinic
Facility Name JACKSON STATE UNIVERSITY-COMMUNITY HEALTH PROGRAM
Street 1400 LYNCH ST--LIBERAL ARTS BLDG, RM 124
City JACKSON
State MS
ZIP 39217
Phone 601 979-1551
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/18/2024
Certificate Expiration Date 10/17/2026
Facility Type Community Clinic
Lab Director KAYE F. SLY

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