25D2072196 CLIA NUMBER - NORTH GULFPORT HOME PROGRAM, LLC

Laboratory Demographics

  • CLIA Code: 25D2072196
  • Facility Name: NORTH GULFPORT HOME PROGRAM, LLC
  • Facility Address: 3301 25TH AVENUE
    GULFPORT, MS
    ZIP 39501
  • Facility Phone: 228 436-9819
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. DOUGLAS C. LANIER
  • NPI Number: 1124576079
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 25D2072196
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name NORTH GULFPORT HOME PROGRAM, LLC
Street 3301 25TH AVENUE
City GULFPORT
State MS
ZIP 39501
Phone 228 436-9819
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/27/2024
Certificate Expiration Date 1/26/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. DOUGLAS C. LANIER

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