25D2106956 CLIA NUMBER - SOUTHEAST UROGYN LLC

Laboratory Demographics

  • CLIA Code: 25D2106956
  • Facility Name: SOUTHEAST UROGYN LLC
  • Facility Address: 1040 RIVER OAKS DR STE 101/103
    FLOWOOD, MS
    ZIP 39232
  • Facility Phone: 601 948-6540
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBIN JACKSON
  • NPI Number: 1548513617
  • Taxonomy: 207VF0040X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 25D2106956
LAB Type Physician Office
Facility Name SOUTHEAST UROGYN LLC
Street 1040 RIVER OAKS DR STE 101/103
City FLOWOOD
State MS
ZIP 39232
Phone 601 948-6540
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/4/2024
Certificate Expiration Date 1/3/2026
Facility Type Physician Office
Lab Director ROBIN JACKSON

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