25D2019409 CLIA NUMBER - PETAL URGENT CARE CLINIC

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Laboratory Demographics

CLIA Number: 25D2019409

Facility Name: PETAL URGENT CARE CLINIC

Facility Address:
1272 EVELYN GANDY PARKWAY STE 60
PETAL, MS
ZIP 39465
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Facility Phone Number: 601 336-5393

Facility Type: Other - URGENT CARE

Certificate Type: Waiver

NPI Number: 1982908877

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2019409
LAB Type	Other - URGENT CARE
Facility Name	PETAL URGENT CARE CLINIC
Street	1272 EVELYN GANDY PARKWAY STE 60
City	PETAL
State	MS
ZIP	39465
Phone	601 336-5393
CertificateType	4
CertificateEffectiveDate	1/28/2023
CertificateExpirationDate	1/27/2025
FacilityType	Waiver

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