25D2158625 CLIA NUMBER - FAST PACE MISSISSIPPI, PLLC

Laboratory Demographics

  • CLIA Code: 25D2158625
  • Facility Name: FAST PACE MISSISSIPPI, PLLC
  • Facility Address: 305 HILL STREET
    ELLISVILLE, MS
    ZIP 39437
  • Facility Phone: 601 800-0118
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DANA MARTIN
  • NPI Number: 1740947019
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2158625
LAB Type Physician Office
Facility Name FAST PACE MISSISSIPPI, PLLC
Street 305 HILL STREET
City ELLISVILLE
State MS
ZIP 39437
Phone 601 800-0118
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2024
Certificate Expiration Date 12/2/2026
Facility Type Physician Office
Lab Director DANA MARTIN

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