25D2184536 CLIA NUMBER - CHRIS PARK DO PC DBA PARK MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 25D2184536
  • Facility Name: CHRIS PARK DO PC DBA PARK MEDICAL CLINIC
  • Facility Address: 47 S MAIN STREET
    PONTOTOC, MS
    ZIP 38863
  • Facility Phone: 662 499-2802
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. CHRISTOPHER L. PARK
  • NPI Number: 1831710623
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 25D2184536
LAB Type Physician Office
Facility Name CHRIS PARK DO PC DBA PARK MEDICAL CLINIC
Street 47 S MAIN STREET
City PONTOTOC
State MS
ZIP 38863
Phone 662 499-2802
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2024
Certificate Expiration Date 5/20/2026
Facility Type Physician Office
Lab Director DR. CHRISTOPHER L. PARK

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