25D2279015 CLIA NUMBER - LUCEDALE FAMILY MEDICAL CLINIC LLC

Laboratory Demographics

CLIA Code: 25D2279015
Facility Name: LUCEDALE FAMILY MEDICAL CLINIC LLC
Facility Address: 223 WINTER ST STE D
LUCEDALE, MS
ZIP 39452
Facility Phone: 251 680-7526
Facility Type: Practitioner Other
Facility Type: Waiver
Lab Director: NORMAN M. PARNELL
NPI Number: 1790116838
Taxonomy: 390200000X - Student in an Organized Health Care Education/Training Program

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CLIA Record

Field Name	Field Value
CLIA Number	25D2279015
LAB Type	Practitioner Other
Facility Name	LUCEDALE FAMILY MEDICAL CLINIC LLC
Street	223 WINTER ST STE D
City	LUCEDALE
State	MS
ZIP	39452
Phone	251 680-7526
Certificate Type	Certificate of Waiver
Certificate Type Description	This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date	3/28/2025
Certificate Expiration Date	3/27/2027
Facility Type	Practitioner Other
Lab Director	NORMAN M. PARNELL

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This page was last updated on: 6/4/2025