SOUTH JACKSON WIC DISTRIBUTION
NPI 1366853004
Public Health or Welfare in Jackson, MS
About South Jackson Wic Distribution NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SOUTH JACKSON WIC DISTRIBUTION (NPI 1366853004) is a healthcare organization registered as a public health or welfare in Jackson, Mississippi and active in the NPI registry since May 2014. The organization holds a CLIA Microscopy certificate valid through August 6, 2027 and lists Mitchell Adcock, Chief Administrative Officer, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 25D0931907
- Facility Type
- Community Clinic
- Certificate Effective Date
- August 07, 2025
- Certificate Expiration Date
- August 06, 2027
- Laboratory Director
- LYNDA ASSAD
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to South Jackson Wic Distribution in which a physician, midlevel practitioner or dentist that performs specific microscopy procedures during the course of a patient's visit. A limited list of provider-performed microscopy procedures is included under this certificate type, which are categorized as moderate complexity testing.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1366853004, enumerated as an "organization" on May 15, 2014.
The provider is located at 3276 LYNCH ST JACKSON, MS 39209 and the phone number is (601) 969-5730.
Public Health or Welfare with taxonomy code 251K00000X.
