SOUTH JACKSON WIC DISTRIBUTION
NPI 1366853004
Public Health or Welfare in Jackson, MS
- Organization
- Public Health or Welfare
- CLIA Number: 25D0931907
- CLIA Cert. Type: Community Clinic
- CLIA Exp. Date: 08-06-2027
About SOUTH JACKSON WIC DISTRIBUTION
This page provides the complete NPI Profile along with additional information for South Jackson Wic Distribution, a provider established in Jackson, Mississippi operating as a Public Health Or Welfare. The healthcare provider is registered in the NPI registry with number 1366853004 assigned on May 2014. The practitioner's primary taxonomy code is 251K00000X. The provider is registered as an organization and their NPI record was last updated 12 years ago. The provider's other name is South Jackson Wic Distribution. The authorized official of this NPI record is Mr. Mitchell Adcock Cao (Chief Administrative Officer)
- NPI
- 1366853004 Verify this NPI
- Provider Legal Name
- MISSISSIPPI STATE DEPARTMENT OF HEALTH
- Other Organization Name
- SOUTH JACKSON WIC DISTRIBUTION
- Other Name Type
- Other Name (5)
- Entity Type
- Organization
- Location Address
- 3276 LYNCH ST JACKSON, MS 39209
- Location Phone
- (601) 969-5730
- Location Fax
- (601) 969-5729
- Mailing Address
- 570 E WOODROW WILSON AVE JACKSON, MS 39216
- Mailing Phone
- (601) 576-7635
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 05-15-2014
- Last Update Date
- 05-15-2014
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Public Health or Welfare
- Taxonomy Code
- 251K00000X
- Type
- Agencies
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.
Reviews for SOUTH JACKSON WIC DISTRIBUTION
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
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.
