25D2281590 CLIA NUMBER - CLARKSDALE FAMILY MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 25D2281590
  • Facility Name: CLARKSDALE FAMILY MEDICAL CENTER
  • Facility Address: 1209 LEE DR
    CLARKSDALE, MS
    ZIP 38614
  • Facility Phone: 662 326-3500
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. RICHARD E. WALLER
  • NPI Number: 1467949941
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 25D2281590
LAB Type Physician Office
Facility Name CLARKSDALE FAMILY MEDICAL CENTER
Street 1209 LEE DR
City CLARKSDALE
State MS
ZIP 38614
Phone 662 326-3500
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/9/2023
Certificate Expiration Date 5/8/2025
Facility Type Physician Office
Lab Director DR. RICHARD E. WALLER

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This page was last updated on: 3/20/2025