25D2048983 CLIA NUMBER - 149 PEDIATRIC AND FAMILY CLINIC

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Laboratory Demographics

CLIA Number: 25D2048983

Facility Name: 149 PEDIATRIC AND FAMILY CLINIC

Facility Address:
376 SIMPSON HWY 149 STE 300
MAGEE, MS
ZIP 39111
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Facility Phone Number: 601 721-8985

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1154670719

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2048983
LAB Type	Physician Office
Facility Name	149 PEDIATRIC AND FAMILY CLINIC
Street	376 SIMPSON HWY 149 STE 300
City	MAGEE
State	MS
ZIP	39111
Phone	601 721-8985
CertificateType	4
CertificateEffectiveDate	10/26/2022
CertificateExpirationDate	10/25/2024
FacilityType	Waiver

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