25D2125572 CLIA NUMBER - PEDIATRUST COLUMBUS

Laboratory Demographics

  • CLIA Code: 25D2125572
  • Facility Name: PEDIATRUST COLUMBUS
  • Facility Address: 306 HOSPITAL DRIVE
    COLUMBUS, MS
    ZIP 39705
  • Facility Phone: 662 570-1957
  • Facility Type: Other - PRESCR PED EXTENDED CARE
  • Facility Type: Waiver
  • Lab Director: JAMIE HEATON
  • NPI Number: 1639606940
  • Taxonomy: 3140N1450X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 25D2125572
LAB Type Other - PRESCR PED EXTENDED CARE
Facility Name PEDIATRUST COLUMBUS
Street 306 HOSPITAL DRIVE
City COLUMBUS
State MS
ZIP 39705
Phone 662 570-1957
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/9/2025
Certificate Expiration Date 2/8/2027
Facility Type Other - PRESCR PED EXTENDED CARE
Lab Director JAMIE HEATON

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