25D2166244 CLIA NUMBER - FAST PACE MISSISSIPPI, PLLC

Laboratory Demographics

CLIA Number: 25D2166244

Facility Name: FAST PACE MISSISSIPPI, PLLC

Facility Address:
2121 GRAND AVENUE
YAZOO CITY, MS
ZIP 39194
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Facility Phone Number: 662 716-8071

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1821755109

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2166244
LAB Type	Physician Office
Facility Name	FAST PACE MISSISSIPPI, PLLC
Street	2121 GRAND AVENUE
City	YAZOO CITY
State	MS
ZIP	39194
Phone	662 716-8071
CertificateType	4
CertificateEffectiveDate	5/14/2023
CertificateExpirationDate	5/13/2025
FacilityType	Waiver

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