25D1107141 CLIA NUMBER - BAGWELL MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 25D1107141
  • Facility Name: BAGWELL MEDICAL CLINIC
  • Facility Address: 2670 MCINGVALE RD SUITE H
    HERNANDO, MS
    ZIP 38632
  • Facility Phone: 662 560-5966
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KATELYN M. LILES
  • NPI Number: 1881119618
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D1107141
LAB Type Physician Office
Facility Name BAGWELL MEDICAL CLINIC
Street 2670 MCINGVALE RD SUITE H
City HERNANDO
State MS
ZIP 38632
Phone 662 560-5966
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2024
Certificate Expiration Date 2/15/2026
Facility Type Physician Office
Lab Director KATELYN M. LILES

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