25D1089396 CLIA NUMBER - NMMC DBA N MS REGIONAL PAIN CONSULTANT SOUTHRIDGE

Laboratory Demographics

  • CLIA Code: 25D1089396
  • Facility Name: NMMC DBA N MS REGIONAL PAIN CONSULTANT SOUTHRIDGE
  • Facility Address: 4381 SOUTH EASON BLVD SUITE 101
    TUPELO, MS
    ZIP 38801
  • Facility Phone: 662 377-1880
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DR. DREW BLACKSTOCK
  • NPI Number: 1548418320
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D1089396
LAB Type Ambulatory Surgery Center
Facility Name NMMC DBA N MS REGIONAL PAIN CONSULTANT SOUTHRIDGE
Street 4381 SOUTH EASON BLVD SUITE 101
City TUPELO
State MS
ZIP 38801
Phone 662 377-1880
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/17/2024
Certificate Expiration Date 9/16/2026
Facility Type Ambulatory Surgery Center
Lab Director DR. DREW BLACKSTOCK

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