25D2085360 CLIA NUMBER - ELITE CARE FAMILY MEDICINE

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Laboratory Demographics

CLIA Number: 25D2085360

Facility Name: ELITE CARE FAMILY MEDICINE

Facility Address:
571 MITCHELL STREET, STE C
GUNTOWN, MS
ZIP 38849
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Facility Phone Number: 662 348-3342

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1194128306

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2085360
LAB Type	Physician Office
Facility Name	ELITE CARE FAMILY MEDICINE
Street	571 MITCHELL STREET, STE C
City	GUNTOWN
State	MS
ZIP	38849
Phone	662 348-3342
CertificateType	2
CertificateEffectiveDate	10/19/2023
CertificateExpirationDate	10/18/2025
FacilityType	Compliance

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