25D2050942 CLIA NUMBER - CAMPBELL CLINIC - SOUTHAVEN

Laboratory Demographics

  • CLIA Code: 25D2050942
  • Facility Name: CAMPBELL CLINIC - SOUTHAVEN
  • Facility Address: 7545 AIRWAYS BOULEVARD
    SOUTHAVEN, MS
    ZIP 38671
  • Facility Phone: 901 759-3100
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DAVID R. RICHARDSON
  • NPI Number: 1902081938
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 25D2050942
LAB Type Physician Office
Facility Name CAMPBELL CLINIC - SOUTHAVEN
Street 7545 AIRWAYS BOULEVARD
City SOUTHAVEN
State MS
ZIP 38671
Phone 901 759-3100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/10/2024
Certificate Expiration Date 12/9/2026
Facility Type Physician Office
Lab Director DAVID R. RICHARDSON

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