44D2123297 CLIA NUMBER - PA CORPORATE ENTERPRISES LLP DBA SOUTH GIBSON FAMILY CARE

Laboratory Demographics

  • CLIA Code: 44D2123297
  • Facility Name: PA CORPORATE ENTERPRISES LLP DBA SOUTH GIBSON FAMILY CARE
  • Facility Address: 589 HWY 45 SOUTH
    MEDINA, TN
    ZIP 38355
  • Facility Phone: 731 235-0555
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DAVID J. WILBERT
  • NPI Number: 1518226646
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 44D2123297
LAB Type Physician Office
Facility Name PA CORPORATE ENTERPRISES LLP DBA SOUTH GIBSON FAMILY CARE
Street 589 HWY 45 SOUTH
City MEDINA
State TN
ZIP 38355
Phone 731 235-0555
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 12/19/2024
Certificate Expiration Date 12/18/2026
Facility Type Physician Office
Lab Director DAVID J. WILBERT

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