25D2092297 CLIA NUMBER - PRESCRIBED PED DBA PEDIATRIC HEALTH CHOICE

Laboratory Demographics

  • CLIA Code: 25D2092297
  • Facility Name: PRESCRIBED PED DBA PEDIATRIC HEALTH CHOICE
  • Facility Address: 611 PEGRAM DRIVE
    TUPELO, MS
    ZIP 38801
  • Facility Phone: 800 783-9858
  • Facility Type: Other - PPEC
  • Facility Type: Waiver
  • Lab Director: DEBORAH E. FRAZE
  • NPI Number: 1598123572
  • Taxonomy: 261QM3000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2092297
LAB Type Other - PPEC
Facility Name PRESCRIBED PED DBA PEDIATRIC HEALTH CHOICE
Street 611 PEGRAM DRIVE
City TUPELO
State MS
ZIP 38801
Phone 800 783-9858
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/3/2025
Certificate Expiration Date 3/2/2027
Facility Type Other - PPEC
Lab Director DEBORAH E. FRAZE

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