25D2032515 CLIA NUMBER - FAMILY HEALTH CARE CLINIC INC

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Laboratory Demographics

CLIA Number: 25D2032515

Facility Name: FAMILY HEALTH CARE CLINIC INC

Facility Address:
1102 TELEGRAPH STREET
GRENADA, MS
ZIP 38901
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Facility Phone Number: 601 825-7280

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1508099151

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2032515
LAB Type	School/Student Health Service
Facility Name	FAMILY HEALTH CARE CLINIC INC
Street	1102 TELEGRAPH STREET
City	GRENADA
State	MS
ZIP	38901
Phone	601 825-7280
CertificateType	4
CertificateEffectiveDate	11/9/2023
CertificateExpirationDate	11/8/2025
FacilityType	Waiver

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