25D2281586 CLIA NUMBER - MISSISSIPPICARE 127

Laboratory Demographics

  • CLIA Code: 25D2281586
  • Facility Name: MISSISSIPPICARE 127
  • Facility Address: 65 THOMAS ST
    TUPELO, MS
    ZIP 38801
  • Facility Phone: 662 350-7010
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: KRISTINE PRUITT
  • NPI Number: 1316933617
  • Taxonomy: 335E00000X - Prosthetic/Orthotic Supplier

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CLIA Record

Field Name Field Value
CLIA Number 25D2281586
LAB Type Federally Qualified Health Center
Facility Name MISSISSIPPICARE 127
Street 65 THOMAS ST
City TUPELO
State MS
ZIP 38801
Phone 662 350-7010
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/9/2025
Certificate Expiration Date 5/8/2027
Facility Type Federally Qualified Health Center
Lab Director KRISTINE PRUITT

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