25D2309873 CLIA NUMBER - UPSHUR CLINIC, PLLC

Laboratory Demographics

  • CLIA Code: 25D2309873
  • Facility Name: UPSHUR CLINIC, PLLC
  • Facility Address: 111 HIGHWAY 82 EAST, SUITE B
    LELAND, MS
    ZIP 38756
  • Facility Phone: 662 820-0079
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: MELINDA UPSHUR
  • NPI Number: 1962248237
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 25D2309873
LAB Type Practitioner Other
Facility Name UPSHUR CLINIC, PLLC
Street 111 HIGHWAY 82 EAST, SUITE B
City LELAND
State MS
ZIP 38756
Phone 662 820-0079
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/22/2024
Certificate Expiration Date 8/21/2026
Facility Type Practitioner Other
Lab Director MELINDA UPSHUR

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