25D2009508 CLIA NUMBER - HOGAN SURGICAL CENTER, PA

Laboratory Demographics

  • CLIA Code: 25D2009508
  • Facility Name: HOGAN SURGICAL CENTER, PA
  • Facility Address: 351 COWAN ROAD
    GULFPORT, MS
    ZIP 39507
  • Facility Phone: 228 896-1120
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: BREE L. WALLACE
  • NPI Number: 1538338322
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2009508
LAB Type Ambulatory Surgery Center
Facility Name HOGAN SURGICAL CENTER, PA
Street 351 COWAN ROAD
City GULFPORT
State MS
ZIP 39507
Phone 228 896-1120
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2024
Certificate Expiration Date 7/5/2026
Facility Type Ambulatory Surgery Center
Lab Director BREE L. WALLACE

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