25D2248498 CLIA NUMBER - FAST PACE MISSISSIPPI, PLLC

Laboratory Demographics

  • CLIA Code: 25D2248498
  • Facility Name: FAST PACE MISSISSIPPI, PLLC
  • Facility Address: 1612 E COUNTY LINE RD
    RIDGELAND, MS
    ZIP 39157
  • Facility Phone: 931 253-1110
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DANA MARTIN
  • NPI Number: 1790442051
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2248498
LAB Type Physician Office
Facility Name FAST PACE MISSISSIPPI, PLLC
Street 1612 E COUNTY LINE RD
City RIDGELAND
State MS
ZIP 39157
Phone 931 253-1110
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 Physician Office
Lab Director DANA MARTIN

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