25D0691320 CLIA NUMBER - VICKSBURG CONVALESCENT LLC DBA VICKSBURG CONVALESCENT CENTER

Laboratory Demographics

  • CLIA Code: 25D0691320
  • Facility Name: VICKSBURG CONVALESCENT LLC DBA VICKSBURG CONVALESCENT CENTER
  • Facility Address: 1708 CHERRY ST
    VICKSBURG, MS
    ZIP 39180
  • Facility Phone: 601 638-3632
  • Facility Type: Skilled Nursing Facility/Nursing Facility
  • Facility Type: Waiver
  • Lab Director: RUSSELL BARNES MD
  • NPI Number: 1578553459
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 25D0691320
LAB Type Skilled Nursing Facility/Nursing Facility
Facility Name VICKSBURG CONVALESCENT LLC DBA VICKSBURG CONVALESCENT CENTER
Street 1708 CHERRY ST
City VICKSBURG
State MS
ZIP 39180
Phone 601 638-3632
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Skilled Nursing Facility/Nursing Facility
Lab Director RUSSELL BARNES MD

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