25D2290146 CLIA NUMBER - TYSON BIG TREE, LLC

Laboratory Demographics

  • CLIA Code: 25D2290146
  • Facility Name: TYSON BIG TREE, LLC
  • Facility Address: 2159 S LAMAR BLVD, STE B
    OXFORD, MS
    ZIP 38655
  • Facility Phone: 662 236-2222
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROBERT H. LOMENICK
  • NPI Number: 1770338410
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2290146
LAB Type Pharmacy
Facility Name TYSON BIG TREE, LLC
Street 2159 S LAMAR BLVD, STE B
City OXFORD
State MS
ZIP 38655
Phone 662 236-2222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/21/2025
Certificate Expiration Date 9/20/2027
Facility Type Pharmacy
Lab Director ROBERT H. LOMENICK

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