25D2026453 CLIA NUMBER - MADISON OB/GYN ASSOCIATES LLC

Laboratory Demographics

  • CLIA Code: 25D2026453
  • Facility Name: MADISON OB/GYN ASSOCIATES LLC
  • Facility Address: 115 FOUNTAINS BLVD, SUITE A
    MADISON, MS
    ZIP 39110
  • Facility Phone: 601 855-4321
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ERIKA L. TANNER
  • NPI Number: 1699068775
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 25D2026453
LAB Type Physician Office
Facility Name MADISON OB/GYN ASSOCIATES LLC
Street 115 FOUNTAINS BLVD, SUITE A
City MADISON
State MS
ZIP 39110
Phone 601 855-4321
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/30/2025
Certificate Expiration Date 6/29/2027
Facility Type Physician Office
Lab Director ERIKA L. TANNER

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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