25D2159164 CLIA NUMBER - COASTAL FAMILY HEALTH KREOLE SCHOOL CLINIC

Laboratory Demographics

CLIA Number: 25D2159164

Facility Name: COASTAL FAMILY HEALTH KREOLE SCHOOL CLINIC

Facility Address:
6312 MARTIN LUTHER KING BLVD
MOSS POINT, MS
ZIP 39563
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Facility Phone Number: 228 475-3719

Facility Type: School/Student Health Service

Certificate Type: Waiver

NPI Number: 1306343694

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2159164
LAB Type	School/Student Health Service
Facility Name	COASTAL FAMILY HEALTH KREOLE SCHOOL CLINIC
Street	6312 MARTIN LUTHER KING BLVD
City	MOSS POINT
State	MS
ZIP	39563
Phone	228 475-3719
CertificateType	4
CertificateEffectiveDate	12/12/2022
CertificateExpirationDate	12/11/2024
FacilityType	Waiver

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