25D2261840 CLIA NUMBER - WARE FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 25D2261840

Facility Name: WARE FAMILY PRACTICE

Facility Address:
972 COLUMBIA AVENUE
PRENTISS, MS
ZIP 39474
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Facility Phone Number: 601 792-5343

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1730829060

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D2261840
LAB Type	Physician Office
Facility Name	WARE FAMILY PRACTICE
Street	972 COLUMBIA AVENUE
City	PRENTISS
State	MS
ZIP	39474
Phone	601 792-5343
CertificateType	4
CertificateEffectiveDate	6/6/2022
CertificateExpirationDate	6/5/2024
FacilityType	Waiver

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