CLIA lab
CLIA 25D2050591: South Ridge Family Clinic LLC
Ellisville, MS. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 25D2050591 belongs to South Ridge Family Clinic LLC in Ellisville, MS.
Certificate of Waiver, effective March 28, 2025, expires March 27, 2027.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- March 28, 2025
- Certificate expiration
- March 27, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- December 3, 2012
- Facility type
- Other practitioner
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 25D2050591
- Lab name
- South Ridge Family Clinic LLC
- Address
- 80 Hal Crocker Road, Ellisville, MS 39437
- Phone
- (601) 477-2221
- Fax
- (601) 477-2223
Annual test volume the lab reported
- Waived tests
- 2,500
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Ellisville, MS
- Ellisville Family Clinic LaboratoryCertificate of Compliance, Physician office25D0977574
- Ellisville Medical/Obgyn Clinic LabCertificate of Compliance, Other25D0957040
- Ellisville Pediatric ClinicCertificate of Waiver, Rural health clinic25D2070626
- Ellisville State SchoolCertificate of Waiver, Intermediate care facility for individuals with intellectual disabilities25D0030098
- Fast Pace Mississippi, PLLCCertificate of Waiver, Physician office25D2158625
- Interventional Spine & Sports InstituteCertificate of Waiver, Physician office25D2103440
- Jfmc Ellisville LLCCertificate of Waiver, Physician office25D2053253
- Jones County Detention CenterCertificate of Waiver, Prison25D2284642
- Jones County Junior College Health ServicesCertificate of Waiver, School or student health service25D2020826
- Jones County Rest HomeCertificate of Waiver, Skilled nursing or nursing facility25D0651933
Related
Questions
What is the CLIA number for South Ridge Family Clinic LLC in Ellisville?
25D2050591, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does South Ridge Family Clinic LLC hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 25D2050591 expire?
The CMS file lists March 27, 2027 as the certificate expiration date; the certificate took effect March 28, 2025.