25D2278609 CLIA NUMBER - CENTERWELL SENIOR PRIMARY CARE - GULFPORT

Laboratory Demographics

  • CLIA Code: 25D2278609
  • Facility Name: CENTERWELL SENIOR PRIMARY CARE - GULFPORT
  • Facility Address: 12057 US HWY 49 STE C
    GULFPORT, MS
    ZIP 39503
  • Facility Phone: 228 832-9385
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. EARL K. MAGEE
  • NPI Number: 1003528092
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 25D2278609
LAB Type Physician Office
Facility Name CENTERWELL SENIOR PRIMARY CARE - GULFPORT
Street 12057 US HWY 49 STE C
City GULFPORT
State MS
ZIP 39503
Phone 228 832-9385
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/21/2025
Certificate Expiration Date 3/20/2027
Facility Type Physician Office
Lab Director DR. EARL K. MAGEE

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