25D2130740 CLIA NUMBER - RCG MISSISSIPPI INC DBA NESHOBA COUNTY DIALYSIS

Laboratory Demographics

CLIA Number: 25D2130740

Facility Name: RCG MISSISSIPPI INC DBA NESHOBA COUNTY DIALYSIS

Facility Address:
1100 CENTRAL DR
PHILADELPHIA, MS
ZIP 39350
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Facility Phone Number: 601 656-2062

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1710411707

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2130740
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	RCG MISSISSIPPI INC DBA NESHOBA COUNTY DIALYSIS
Street	1100 CENTRAL DR
City	PHILADELPHIA
State	MS
ZIP	39350
Phone	601 656-2062
CertificateType	4
CertificateEffectiveDate	5/16/2023
CertificateExpirationDate	5/15/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024