44D1044475 CLIA NUMBER - DELTA CLINICS, PLC DBA HEART AND VASCULAR CENTER OF WEST TENNESSEE

Laboratory Demographics

  • CLIA Code: 44D1044475
  • Facility Name: DELTA CLINICS, PLC DBA HEART AND VASCULAR CENTER OF WEST TENNESSEE
  • Facility Address: 17 CENTRE PLAZA DR
    JACKSON, TN
    ZIP 38305
  • Facility Phone: 731 512-0104
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. SIMON O. OKEWOLE
  • NPI Number: 1578004453
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 44D1044475
LAB Type Physician Office
Facility Name DELTA CLINICS, PLC DBA HEART AND VASCULAR CENTER OF WEST TENNESSEE
Street 17 CENTRE PLAZA DR
City JACKSON
State TN
ZIP 38305
Phone 731 512-0104
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/8/2025
Certificate Expiration Date 4/7/2027
Facility Type Physician Office
Lab Director DR. SIMON O. OKEWOLE

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