25D2322207 CLIA NUMBER - CHILDREN'S INTERNATIONAL MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 25D2322207
  • Facility Name: CHILDREN'S INTERNATIONAL MEDICAL GROUP
  • Facility Address: 930 HALL STREET, SUITE A
    WIGGINS, MS
    ZIP 39577
  • Facility Phone: 601 798-1238
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. EDUARDO J. HERNANDEZ
  • NPI Number: 1003610171
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2322207
LAB Type Physician Office
Facility Name CHILDREN'S INTERNATIONAL MEDICAL GROUP
Street 930 HALL STREET, SUITE A
City WIGGINS
State MS
ZIP 39577
Phone 601 798-1238
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/16/2025
Certificate Expiration Date 4/15/2027
Facility Type Physician Office
Lab Director DR. EDUARDO J. HERNANDEZ

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