25D2062274 CLIA NUMBER - ANDERSON CHILDREN'S MEDICAL CLINIC

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Laboratory Demographics

CLIA Number: 25D2062274

Facility Name: ANDERSON CHILDREN'S MEDICAL CLINIC

Facility Address:
1600 22ND AVE, MED TOWERS 3, THIRD FLOOR STE B
MERIDIAN, MS
ZIP 39301
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Facility Phone Number: 601 703-8370

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1598105447

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2062274
LAB Type	Physician Office
Facility Name	ANDERSON CHILDREN'S MEDICAL CLINIC
Street	1600 22ND AVE, MED TOWERS 3, THIRD FLOOR STE B
City	MERIDIAN
State	MS
ZIP	39301
Phone	601 703-8370
CertificateType	4
CertificateEffectiveDate	8/26/2022
CertificateExpirationDate	8/25/2024
FacilityType	Waiver

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