25D2101589 CLIA NUMBER - TUPELO VA CLINIC

Laboratory Demographics

  • CLIA Code: 25D2101589
  • Facility Name: TUPELO VA CLINIC
  • Facility Address: 1114 COMMONWEALTH BLVD
    TUPELO, MS
    ZIP 38804
  • Facility Phone: 662 840-6366
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JO A. HARRISON
  • NPI Number: 1073552436
  • Taxonomy: 261QV0200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2101589
LAB Type Physician Office
Facility Name TUPELO VA CLINIC
Street 1114 COMMONWEALTH BLVD
City TUPELO
State MS
ZIP 38804
Phone 662 840-6366
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/4/2025
Certificate Expiration Date 9/3/2027
Facility Type Physician Office
Lab Director JO A. HARRISON

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