Hubcare Pathology Pa At Wesley Medical Center

Independent, Accreditation
Active
Recertification: October 05, 2022
5001 Hardy Street
Hattiesburg, MS 39402

Action history

Action history

Action history

The last certification action type for this lab was "Initial"

Initial certifications in Mississippi by year:
Recertifications in Mississippi by year:

Certificate Type

In Mississippi, by Certificate:

All Fields for HUBCARE PATHOLOGY PA AT WESLEY MEDICAL CENTER

Each field below has a detailed description available. Click the field name in blue for more details on how CMS classifies critical laboratory data.
Field Value
CCN
25D2006846
Provider Category Subtype Code
Clia88 Laboratory
Provider Category Code
Clia Laboratory
CHOW Count
0
CHOW Date
Address: City
Hattiesburg
Compliance: Acceptable POC
N
Compliance: Status
SSA County Code
170
Field (click for description) Value
Cross Ref Provider Number
Certification Date
April 30, 2010
Eligibility Indicator
N
Facility Name
Hubcare Pathology Pa At Wesley Medical Center
Medicare Administrative Contractor (MAC) orIntermediary or Carrier Code
Medicaid Vendor Number
Original Participation Date
April 30, 2010
Prior CHOW Date
Prior Medicare Administrative Contractor (MAC) orIntermediary or Carrier Code
Region Code
Atlanta
Field (click for description) Value
Skeleton Record Indicator
Y
State Abbreviation
Mississippi
SSA State Code
Mississippi
State Region Code
001
Address: Street
5001 Hardy Street
Telephone Number
(601) 268-5995
Termination Code
Active Provider
Termination or Expiration Date
October 05, 2022
Type of Action Code
Initial
Ownership Type Code
PROPRIETARY
Field (click for description) Value
Address: ZIP Code
39402
FIPS State Code
Mississippi
FIPS County Code
035
CBSA Urban Rural Indicator
U
CBSA Code
25620
Address: Street 2nd Line
Affiliated Provider Number 1
Affiliated Provider Number 2
Affiliated Provider Number 3
Affiliated Provider Number 4
Field (click for description) Value
Affiliated Provider Number 5
Affiliated Provider Number 6
Affiliated Provider Number 7
Affiliated Provider Number 8
AO A2LA Accredited Code
AO A2LA Accredited Y Match Date
AO A2LA Accredited Y Match Indicator
N
AO AABB Accredited Code
AO AABB Accredited Y Match Date
AO AABB Accredited Y Match Indicator
N
Field (click for description) Value
AO AOA Accredited Code
AO AOA Accredited Y Match Date
AO AOA Accredited Y Match Indicator
N
AO ASHI Accredited Code
AO ASHI Accredited Y Match Date
AO ASHI Accredited Y Match Indicator
N
AO CAP Accredited Code
Accredited
AO CAP Accredited Y Match Date
October 06, 2010
AO CAP Accredited Y Match Indicator
Y
AO COLA Accredited Code
Field (click for description) Value
AO COLA Accredited Y Match Date
AO COLA Accredited Y Match Indicator
N
AO JC Accredited Code
AO JC Accredited Y Match Date
AO JC Accredited Y Match Indicator
N
Application Received SA Date
April 30, 2010
Application Type Code
Accreditation
Category-specific Facility Type Code
Independent
CLIA Certificate Effective Date
October 06, 2020
CLIA Certificate Mailed Date
September 08, 2020
Field (click for description) Value
CLIA Certificate Type Code
Accreditation
Current CLIA Lab Clsfctn CD
Clia Laboratory
CLIA Lab Classification CD 1
Clia Laboratory
CLIA Lab Classification CD 10
CLIA Lab Classification CD 2
Clia Laboratory
CLIA Lab Classification CD 3
Clia Laboratory
CLIA Lab Classification CD 4
Clia Laboratory
CLIA Lab Classification CD 5
Clia Laboratory
CLIA Lab Classification CD 6
Clia Laboratory
CLIA Lab Classification CD 7
Clia Laboratory
Field (click for description) Value
CLIA Lab Classification CD 8
CLIA Lab Classification CD 9
CLIA Medicare Number
CLIA Termination Code
Active Provider
CMS-116 Accreditation Schedule Code
Total Volume: 1 To 2,000
CMS-116 Accredited Annual Test Volume
350
CMS-116 Annual Test Volume
0
Director Affiliated Lab Count
0
Fax Phone Number
Fiscal Year End Date (MMDD)
Field (click for description) Value
Multiple Site Certificate Indicator
N
Multiple Site Exception: Hospital Campus Indicator
N
Multiple Site Exception: Public Health Indicator
N
Multiple Site Exception: Temporary Testing SiteIndicator
N
Multiple Site Lab Count
0
PPM Test Volume Count
0
Provider Name 2nd Line
Related Provider Number
Shared Lab Indicator
N
Shared Lab Xref Number
Field (click for description) Value
Survey Compliance Certificate Schedule Code
Survey Compliance Schedule Code
Survey Test Volume Count
0
Waived Test Volume Count
0

Looking for more?

Try the links below for alternate sources. CMS Demographics data is usually the most helpful, followed by a manual CDC lookup.
The authoritative reference for test volume, affiliate numbers, and Laboratory History is the CMS Provider of Services file.
There are many great providers of laboratory data. We encourage you to compare them and find the best source for your specific needs. A good place to start is a Google Search for provider 25D2006846.

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