25D2087126 CLIA NUMBER - IVANCIC PEDIATRIC CLINIC, PA

Home > CLIA Lookup > 25D2087126

Laboratory Demographics

CLIA Number: 25D2087126

Facility Name: IVANCIC PEDIATRIC CLINIC, PA

Facility Address:
499 GLOSTER CREEK VILLAGE, SUITE H-3
TUPELO, MS
ZIP 38801
Get Directions

Facility Phone Number: 662 840-6026

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1942606256

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2087126
LAB Type	Physician Office
Facility Name	IVANCIC PEDIATRIC CLINIC, PA
Street	499 GLOSTER CREEK VILLAGE, SUITE H-3
City	TUPELO
State	MS
ZIP	38801
Phone	662 840-6026
CertificateType	2
CertificateEffectiveDate	7/20/2023
CertificateExpirationDate	7/19/2025
FacilityType	Compliance

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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