25D2254328 CLIA NUMBER - MID-SOUTH DIRECT PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 25D2254328
  • Facility Name: MID-SOUTH DIRECT PRIMARY CARE
  • Facility Address: 1229 MS-42 STE 270
    PETAL, MS
    ZIP 39465
  • Facility Phone: 769 223-9503
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ASHLEE HENDRY
  • NPI Number: 1346036977
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2254328
LAB Type Physician Office
Facility Name MID-SOUTH DIRECT PRIMARY CARE
Street 1229 MS-42 STE 270
City PETAL
State MS
ZIP 39465
Phone 769 223-9503
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/2/2024
Certificate Expiration Date 3/1/2026
Facility Type Physician Office
Lab Director DR. ASHLEE HENDRY

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