44D1094923 CLIA NUMBER - TRINITY MEDICAL CLINIC, LLC

Laboratory Demographics

  • CLIA Code: 44D1094923
  • Facility Name: TRINITY MEDICAL CLINIC, LLC
  • Facility Address: 832 MULBERRY AVE
    SELMER, TN
    ZIP 38375
  • Facility Phone: 731 434-0200
  • Facility Type: Practitioner Other
  • Facility Type: Microscopy
  • Lab Director: DR. MARY J. FULLWOOD
  • NPI Number: 1013156629
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 44D1094923
LAB Type Practitioner Other
Facility Name TRINITY MEDICAL CLINIC, LLC
Street 832 MULBERRY AVE
City SELMER
State TN
ZIP 38375
Phone 731 434-0200
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 3/21/2025
Certificate Expiration Date 3/20/2027
Facility Type Practitioner Other
Lab Director DR. MARY J. FULLWOOD

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