25D2073121 CLIA NUMBER - SOUTH CENTRAL PRIMARY CARE SERVICES

Laboratory Demographics

  • CLIA Code: 25D2073121
  • Facility Name: SOUTH CENTRAL PRIMARY CARE SERVICES
  • Facility Address: 1008 N 15TH AVE
    LAUREL, MS
    ZIP 39440
  • Facility Phone: 601 426-5125
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. KELLY TULLOS
  • NPI Number: 1861037749
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2073121
LAB Type Physician Office
Facility Name SOUTH CENTRAL PRIMARY CARE SERVICES
Street 1008 N 15TH AVE
City LAUREL
State MS
ZIP 39440
Phone 601 426-5125
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/11/2024
Certificate Expiration Date 2/10/2026
Facility Type Physician Office
Lab Director DR. KELLY TULLOS

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This page was last updated on: 3/20/2025