25D2150750 CLIA NUMBER - FAST PACE MISSISSIPPI, PLLC

Laboratory Demographics

  • CLIA Code: 25D2150750
  • Facility Name: FAST PACE MISSISSIPPI, PLLC
  • Facility Address: 619 S STATE STREET
    CLARKSDALE, MS
    ZIP 38614
  • Facility Phone: 662 966-1012
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DANA MARTIN
  • NPI Number: 1013674373
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2150750
LAB Type Physician Office
Facility Name FAST PACE MISSISSIPPI, PLLC
Street 619 S STATE STREET
City CLARKSDALE
State MS
ZIP 38614
Phone 662 966-1012
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/2/2024
Certificate Expiration Date 7/1/2026
Facility Type Physician Office
Lab Director DANA MARTIN

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