25D2108957 CLIA NUMBER - GULF ISLANDS HOME TRAINING

Laboratory Demographics

  • CLIA Code: 25D2108957
  • Facility Name: GULF ISLANDS HOME TRAINING
  • Facility Address: 3200 MALLETT ROAD, SUITE F
    DIBERVILLE, MS
    ZIP 39540
  • Facility Phone: 228 354-9578
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. TRACY PITTMAN
  • NPI Number: 1891151817
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2108957
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name GULF ISLANDS HOME TRAINING
Street 3200 MALLETT ROAD, SUITE F
City DIBERVILLE
State MS
ZIP 39540
Phone 228 354-9578
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/16/2024
Certificate Expiration Date 2/15/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. TRACY PITTMAN

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This page was last updated on: 3/20/2025