25D0317819 CLIA NUMBER - VICKSBURG CLIN DBA PHYSICIAN PRACT OF RIVER REGION

Laboratory Demographics

  • CLIA Code: 25D0317819
  • Facility Name: VICKSBURG CLIN DBA PHYSICIAN PRACT OF RIVER REGION
  • Facility Address: 3317 PEMBERTON SQUARE BLVD
    VICKSBURG, MS
    ZIP 39180
  • Facility Phone: 601 636-1173
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. THOMAS K. SLIGH
  • NPI Number: 1790711158
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 25D0317819
LAB Type Physician Office
Facility Name VICKSBURG CLIN DBA PHYSICIAN PRACT OF RIVER REGION
Street 3317 PEMBERTON SQUARE BLVD
City VICKSBURG
State MS
ZIP 39180
Phone 601 636-1173
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 5/26/2025
Certificate Expiration Date 5/25/2027
Facility Type Physician Office
Lab Director DR. THOMAS K. SLIGH

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This page was last updated on: 9/29/2025