25D2177508 CLIA NUMBER - MISSISSIPPICARE 129

Laboratory Demographics

  • CLIA Code: 25D2177508
  • Facility Name: MISSISSIPPICARE 129
  • Facility Address: 2173 S LAMAR BLVD
    OXFORD, MS
    ZIP 38655
  • Facility Phone: 662 234-6553
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: KRISTINE PRUITT
  • NPI Number: 1366845554
  • Taxonomy: 367500000X - Nurse Anesthetist, Certified Registered

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CLIA Record

Field Name Field Value
CLIA Number 25D2177508
LAB Type Federally Qualified Health Center
Facility Name MISSISSIPPICARE 129
Street 2173 S LAMAR BLVD
City OXFORD
State MS
ZIP 38655
Phone 662 234-6553
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/13/2024
Certificate Expiration Date 1/12/2026
Facility Type Federally Qualified Health Center
Lab Director KRISTINE PRUITT

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