JACKSON FREE CLINIC
NPI 1851068324
Voluntary or Charitable in Jackson, MS
- Organization
- Voluntary or Charitable
- CLIA Number: 25D0995019
- CLIA Cert. Type: Community Clinic
- CLIA Exp. Date: 01-07-2028
About JACKSON FREE CLINIC
This page provides the complete NPI Profile along with additional information for Jackson Free Clinic, a provider established in Jackson, Mississippi operating as a Voluntary Or Charitable. The healthcare provider is registered in the NPI registry with number 1851068324 assigned on August 2021. The practitioner's primary taxonomy code is 251V00000X. The provider is registered as an organization and their NPI record was last updated 4 years ago. The provider's former legal business name is Jackson Free Clinic For The Homeless. The authorized official of this NPI record is Hali Peterson (Chair Of The Board)
- NPI
- 1851068324 Verify this NPI
- Provider Legal Name
- JACKSON FREE CLINIC
- Other Organization Name
- JACKSON FREE CLINIC FOR THE HOMELESS
- Other Name Type
- Former Legal Business Name (4)
- Entity Type
- Organization
- Location Address
- 925 MARTIN LUTHER KING JR DR JACKSON, MS 39203
- Location Phone
- (601) 355-5161
- Mailing Address
- PO BOX 4892 JACKSON, MS 39296
- Mailing Phone
- (601) 355-5161
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 08-24-2021
- Last Update Date
- 06-21-2022
- 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
Voluntary or Charitable
- Taxonomy Code
- 251V00000X
- 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
- 25D0995019
- Facility Type
- Community Clinic
- Certificate Effective Date
- January 08, 2026
- Certificate Expiration Date
- January 07, 2028
- Laboratory Director
- DR. JAMES A. CLOY
- Certificate Type
- Certificate for Provider-Performed Microscopy Procedures (PPMP)
- Certificate Type Description
- This CLIA certificate is issued to Jackson Free Clinic 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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Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1851068324, enumerated as an "organization" on August 24, 2021.
The provider is located at 925 MARTIN LUTHER KING JR DR JACKSON, MS 39203 and the phone number is (601) 355-5161.
Voluntary or Charitable with taxonomy code 251V00000X.
