25D2305429 CLIA NUMBER - MPC SOUTHERN MISSISSIPPI HEART CENTER GULFPORT

Laboratory Demographics

  • CLIA Code: 25D2305429
  • Facility Name: MPC SOUTHERN MISSISSIPPI HEART CENTER GULFPORT
  • Facility Address: 15465 OAK LANE 100-F
    GULFPORT, MS
    ZIP 39503
  • Facility Phone: 228 575-8020
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ASHLEY ROSS
  • NPI Number: 1568558161
  • Taxonomy: 251B00000X - Case Management

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CLIA Record

Field Name Field Value
CLIA Number 25D2305429
LAB Type Physician Office
Facility Name MPC SOUTHERN MISSISSIPPI HEART CENTER GULFPORT
Street 15465 OAK LANE 100-F
City GULFPORT
State MS
ZIP 39503
Phone 228 575-8020
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/30/2024
Certificate Expiration Date 5/29/2026
Facility Type Physician Office
Lab Director ASHLEY ROSS

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