25D2070626 CLIA NUMBER - ELLISVILLE PEDIATRIC CLINIC

Laboratory Demographics

  • CLIA Code: 25D2070626
  • Facility Name: ELLISVILLE PEDIATRIC CLINIC
  • Facility Address: 1203 AVENUE B SUITE
    ELLISVILLE, MS
    ZIP 39437
  • Facility Phone: 601 477-3550
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: MARGARET WILLIAMS
  • NPI Number: 1427098003
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2070626
LAB Type Rural Health Clinic
Facility Name ELLISVILLE PEDIATRIC CLINIC
Street 1203 AVENUE B SUITE
City ELLISVILLE
State MS
ZIP 39437
Phone 601 477-3550
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/20/2023
Certificate Expiration Date 12/19/2025
Facility Type Rural Health Clinic
Lab Director MARGARET WILLIAMS

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