25D2306858 CLIA NUMBER - PERSONAL PEDIATRIC CARE OF PICAYUNE LLC

Laboratory Demographics

  • CLIA Code: 25D2306858
  • Facility Name: PERSONAL PEDIATRIC CARE OF PICAYUNE LLC
  • Facility Address: 104 STREET A
    PICAYUNE, MS
    ZIP 39466
  • Facility Phone: 225 362-9553
  • Facility Type: Other - PEDIATRIC EXTENDED CARE
  • Facility Type: Waiver
  • Lab Director: ROBIN CORNELL
  • NPI Number: 1700230117
  • Taxonomy: 3140N1450X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 25D2306858
LAB Type Other - PEDIATRIC EXTENDED CARE
Facility Name PERSONAL PEDIATRIC CARE OF PICAYUNE LLC
Street 104 STREET A
City PICAYUNE
State MS
ZIP 39466
Phone 225 362-9553
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/25/2024
Certificate Expiration Date 6/24/2026
Facility Type Other - PEDIATRIC EXTENDED CARE
Lab Director ROBIN CORNELL

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