25D1073931 CLIA NUMBER - SGH MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 25D1073931

Facility Name: SGH MEDICAL CLINIC

Facility Address:
1827C SIMPSON HIGHWAY 149
MENDENHALL, MS
ZIP 39114
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Facility Phone Number: 601 847-7118

Facility Type: Rural Health Clinic

Certificate Type: Microscopy

NPI Number: 1609069962

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D1073931
LAB Type	Rural Health Clinic
Facility Name	SGH MEDICAL CLINIC
Street	1827C SIMPSON HIGHWAY 149
City	MENDENHALL
State	MS
ZIP	39114
Phone	601 847-7118
CertificateType	3
CertificateEffectiveDate	9/19/2023
CertificateExpirationDate	9/18/2025
FacilityType	PPMP

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