25D2257883 CLIA NUMBER - MAXEM URGENT CARE

Laboratory Demographics

CLIA Number: 25D2257883

Facility Name: MAXEM URGENT CARE

Facility Address:
4910 OLD HWY 11
HATTIESBURG, MS
ZIP 39402
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Facility Phone Number: 601 909-6240

Facility Type: Other - URGENT CARE

Certificate Type: Waiver

NPI Number: 1699432765

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2257883
LAB Type	Other - URGENT CARE
Facility Name	MAXEM URGENT CARE
Street	4910 OLD HWY 11
City	HATTIESBURG
State	MS
ZIP	39402
Phone	601 909-6240
CertificateType	4
CertificateEffectiveDate	4/12/2024
CertificateExpirationDate	4/11/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024