25D2030791 CLIA NUMBER - OCHSNER HEALTH CENTER - DEKALB

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Laboratory Demographics

CLIA Number: 25D2030791

Facility Name: OCHSNER HEALTH CENTER - DEKALB

Facility Address:
30 PONDEROSA AVE
DE KALB, MS
ZIP 39328
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Facility Phone Number: 601 743-4626

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1912348616

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2030791
LAB Type	Rural Health Clinic
Facility Name	OCHSNER HEALTH CENTER - DEKALB
Street	30 PONDEROSA AVE
City	DE KALB
State	MS
ZIP	39328
Phone	601 743-4626
CertificateType	4
CertificateEffectiveDate	10/31/2023
CertificateExpirationDate	10/30/2025
FacilityType	Waiver

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