25D2026602 CLIA NUMBER - BIENVILLE ORTHOPAEDIC SPECIALISTS

Laboratory Demographics

  • CLIA Code: 25D2026602
  • Facility Name: BIENVILLE ORTHOPAEDIC SPECIALISTS
  • Facility Address: 15476 B DEDEAUX ROAD
    GULFPORT, MS
    ZIP 39503
  • Facility Phone: 228 679-3002
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DONNIS HARRISON
  • NPI Number: 1689804668
  • Taxonomy: 207X00000X - Orthopaedic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 25D2026602
LAB Type Physician Office
Facility Name BIENVILLE ORTHOPAEDIC SPECIALISTS
Street 15476 B DEDEAUX ROAD
City GULFPORT
State MS
ZIP 39503
Phone 228 679-3002
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2025
Certificate Expiration Date 7/5/2027
Facility Type Physician Office
Lab Director DONNIS HARRISON

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