25D2166207 CLIA NUMBER - COASTAL FAMILY HEALTH CENTER LUCEDALE

Laboratory Demographics

CLIA Number: 25D2166207

Facility Name: COASTAL FAMILY HEALTH CENTER LUCEDALE

Facility Address:
11231 OLD 63 SOUTH SUITE C-1
LUCEDALE, MS
ZIP 39452
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Facility Phone Number: 601 947-8268

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1861950982

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2166207
LAB Type	Federally Qualified Health Center
Facility Name	COASTAL FAMILY HEALTH CENTER LUCEDALE
Street	11231 OLD 63 SOUTH SUITE C-1
City	LUCEDALE
State	MS
ZIP	39452
Phone	601 947-8268
CertificateType	3
CertificateEffectiveDate	5/14/2023
CertificateExpirationDate	5/13/2025
FacilityType	PPMP

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