25D2156332 CLIA NUMBER - CHILDREN'S INTERNATIONAL MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 25D2156332
  • Facility Name: CHILDREN'S INTERNATIONAL MEDICAL GROUP
  • Facility Address: 2003 WILDWOOD RD
    PICAYUNE, MS
    ZIP 39466
  • Facility Phone: 601 215-8060
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. EDUARDO J. HERNANDEZ
  • NPI Number: 1356886634
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2156332
LAB Type Physician Office
Facility Name CHILDREN'S INTERNATIONAL MEDICAL GROUP
Street 2003 WILDWOOD RD
City PICAYUNE
State MS
ZIP 39466
Phone 601 215-8060
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/16/2024
Certificate Expiration Date 10/15/2026
Facility Type Physician Office
Lab Director DR. EDUARDO J. HERNANDEZ

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