25D2036203 CLIA NUMBER - MISSISSIPPICARE 113

Laboratory Demographics

  • CLIA Code: 25D2036203
  • Facility Name: MISSISSIPPICARE 113
  • Facility Address: 353 HWY 15 N
    PONTOTOC, MS
    ZIP 38863
  • Facility Phone: 662 490-1985
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: KRISTINE PRUITT
  • NPI Number: 1699292797
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2036203
LAB Type Federally Qualified Health Center
Facility Name MISSISSIPPICARE 113
Street 353 HWY 15 N
City PONTOTOC
State MS
ZIP 38863
Phone 662 490-1985
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/20/2025
Certificate Expiration Date 10/19/2027
Facility Type Federally Qualified Health Center
Lab Director KRISTINE PRUITT

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