25D2076967 CLIA NUMBER - JACKSON HINDS COMP HEALTH CENTER MOBILE UNITS

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Laboratory Demographics

CLIA Number: 25D2076967

Facility Name: JACKSON HINDS COMP HEALTH CENTER MOBILE UNITS

Facility Address:
3502 W NORTHSIDE DRIVE
JACKSON, MS
ZIP 39213
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Facility Phone Number: 601 362-5321

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1861424145

Taxonomy: 261QD0000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2076967
LAB Type	School/Student Health Service
Facility Name	JACKSON HINDS COMP HEALTH CENTER MOBILE UNITS
Street	3502 W NORTHSIDE DRIVE
City	JACKSON
State	MS
ZIP	39213
Phone	601 362-5321
CertificateType	4
CertificateEffectiveDate	4/29/2024
CertificateExpirationDate	4/28/2026
FacilityType	Waiver

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