25D1086365 CLIA NUMBER - RUNNELS PLASTIC SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 25D1086365
  • Facility Name: RUNNELS PLASTIC SURGERY CENTER LLC
  • Facility Address: 1057 RIVER OAKS DRIVE
    FLOWOOD, MS
    ZIP 39232
  • Facility Phone: 601 939-9778
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DR. RUDOLPH S. RUNNELS
  • NPI Number: 1275780660
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D1086365
LAB Type Ambulatory Surgery Center
Facility Name RUNNELS PLASTIC SURGERY CENTER LLC
Street 1057 RIVER OAKS DRIVE
City FLOWOOD
State MS
ZIP 39232
Phone 601 939-9778
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/10/2024
Certificate Expiration Date 7/9/2026
Facility Type Ambulatory Surgery Center
Lab Director DR. RUDOLPH S. RUNNELS

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