25D2176198 CLIA NUMBER - FAST PACE MISSISSIPPI, PLLC

Laboratory Demographics

CLIA Number: 25D2176198

Facility Name: FAST PACE MISSISSIPPI, PLLC

Facility Address:
1400 HIGHWAY 72 E
CORINTH, MS
ZIP 38834
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Facility Phone Number: 662 664-5538

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1124785407

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2176198
LAB Type	Physician Office
Facility Name	FAST PACE MISSISSIPPI, PLLC
Street	1400 HIGHWAY 72 E
City	CORINTH
State	MS
ZIP	38834
Phone	662 664-5538
CertificateType	4
CertificateEffectiveDate	12/10/2023
CertificateExpirationDate	12/9/2025
FacilityType	Waiver

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