Mississippi Testing Laboratories, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MISSISSIPPI TESTING LABORATORIES, LLC

Practice address

152 Watford Park Way Dr
Canton, MS 39046-7900

Phone

(601) 507-8177

Fax

(601) 932-0837

NPI assigned

May 18, 2015

Last updated

May 18, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David L Powe

Title

Manager

Phone

(601) 507-8177

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431907200000",
    "number": "1619355039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 WATFORD PARK WAY DR",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390467900",
            "telephone_number": "601-212-5511",
            "fax_number": "601-932-0837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 WATFORD PARK WAY DR",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390467900",
            "telephone_number": "601-507-8177",
            "fax_number": "601-932-0837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSISSIPPI TESTING LABORATORIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-18",
        "last_updated": "2015-05-18",
        "status": "A",
        "authorized_official_last_name": "POWE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "601-507-8177"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mississippi State Department of Health
• Darling Sharee Mitchell
• Caitlyn Mizelle, MS, CCC-SLP
• Jerri Lynne Molder, OTR/L
• Maria Moman Moman, M.D.
• Adam M Moore, MPT

• Clinical Medical Laboratory in Canton, MS
• Providers in Canton, MS by specialty
• Clinical Medical Laboratory in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.