25D2090287 CLIA NUMBER - SUPERIOR HEALTH AND WELLNESS

Laboratory Demographics

  • CLIA Code: 25D2090287
  • Facility Name: SUPERIOR HEALTH AND WELLNESS
  • Facility Address: 2085 GOODMAN RD W STE 50
    HORN LAKE, MS
    ZIP 38637
  • Facility Phone: 662 253-8459
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. DIANE FERGUSON
  • NPI Number: 1396134151
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 25D2090287
LAB Type Physician Office
Facility Name SUPERIOR HEALTH AND WELLNESS
Street 2085 GOODMAN RD W STE 50
City HORN LAKE
State MS
ZIP 38637
Phone 662 253-8459
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/1/2024
Certificate Expiration Date 5/31/2026
Facility Type Physician Office
Lab Director DR. DIANE FERGUSON

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