25D0926986 CLIA NUMBER - DIAMOND GROVE CENTER LLC

Laboratory Demographics

  • CLIA Code: 25D0926986
  • Facility Name: DIAMOND GROVE CENTER LLC
  • Facility Address: 12356 HWY 15 SOUTH
    LOUISVILLE, MS
    ZIP 39339
  • Facility Phone: 601 779-0119
  • Facility Type: Hospital
  • Facility Type: Waiver
  • Lab Director: VICKI PETERSON
  • NPI Number: 1770617086
  • Taxonomy: 2084P0800X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 25D0926986
LAB Type Hospital
Facility Name DIAMOND GROVE CENTER LLC
Street 12356 HWY 15 SOUTH
City LOUISVILLE
State MS
ZIP 39339
Phone 601 779-0119
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/7/2025
Certificate Expiration Date 4/6/2027
Facility Type Hospital
Lab Director VICKI PETERSON

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