25D2042850 CLIA NUMBER - SHAW FAMILY MEDICAL

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Laboratory Demographics

CLIA Number: 25D2042850

Facility Name: SHAW FAMILY MEDICAL

Facility Address:
112 W PEELER AVE
SHAW, MS
ZIP 38773
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Facility Phone Number: 662 754-3301

Facility Type: Practitioner Other

Certificate Type: Microscopy

NPI Number: 1750642633

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	25D2042850
LAB Type	Practitioner Other
Facility Name	SHAW FAMILY MEDICAL
Street	112 W PEELER AVE
City	SHAW
State	MS
ZIP	38773
Phone	662 754-3301
CertificateType	3
CertificateEffectiveDate	6/21/2022
CertificateExpirationDate	6/20/2024
FacilityType	PPMP

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