25D2179429 CLIA NUMBER - KIDZ 1ST CLINIC LLC

Laboratory Demographics

  • CLIA Code: 25D2179429
  • Facility Name: KIDZ 1ST CLINIC LLC
  • Facility Address: 321 E FIFTEENTH ST
    YAZOO CITY, MS
    ZIP 39194
  • Facility Phone: 662 532-1543
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: TIFFANY A. BOWEN
  • NPI Number: 1083265284
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2179429
LAB Type Practitioner Other
Facility Name KIDZ 1ST CLINIC LLC
Street 321 E FIFTEENTH ST
City YAZOO CITY
State MS
ZIP 39194
Phone 662 532-1543
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/24/2024
Certificate Expiration Date 2/23/2026
Facility Type Practitioner Other
Lab Director TIFFANY A. BOWEN

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