25D2022088 CLIA NUMBER - 4 THE FAMILY HEALTHCARE

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Laboratory Demographics

CLIA Number: 25D2022088

Facility Name: 4 THE FAMILY HEALTHCARE

Facility Address:
1127 OLD FANNIN ROAD, C
BRANDON, MS
ZIP 39047
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Facility Phone Number: 601 919-1090

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1184913014

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	25D2022088
LAB Type	Practitioner Other
Facility Name	4 THE FAMILY HEALTHCARE
Street	1127 OLD FANNIN ROAD, C
City	BRANDON
State	MS
ZIP	39047
Phone	601 919-1090
CertificateType	4
CertificateEffectiveDate	3/28/2023
CertificateExpirationDate	3/27/2025
FacilityType	Waiver

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