25D2172355 CLIA NUMBER - REVITALIZE HYDRATION THERAPY

Laboratory Demographics

  • CLIA Code: 25D2172355
  • Facility Name: REVITALIZE HYDRATION THERAPY
  • Facility Address: 885 LIBERTY RD, SUITE 300
    FLOWOOD, MS
    ZIP 39232
  • Facility Phone: 601 213-0069
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JOHN C. MAY
  • NPI Number: 1285261123
  • Taxonomy: 363LG0600X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 25D2172355
LAB Type Practitioner Other
Facility Name REVITALIZE HYDRATION THERAPY
Street 885 LIBERTY RD, SUITE 300
City FLOWOOD
State MS
ZIP 39232
Phone 601 213-0069
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2025
Certificate Expiration Date 9/22/2027
Facility Type Practitioner Other
Lab Director JOHN C. MAY

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