25D1068392 CLIA NUMBER - COMPLETE CARE RURAL HEALTH CLINIC

Laboratory Demographics

CLIA Number: 25D1068392

Facility Name: COMPLETE CARE RURAL HEALTH CLINIC

Facility Address:
1911 MISSION 66 STE B
VICKSBURG, MS
ZIP 39180
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Facility Phone Number: 601 665-4162

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1669835310

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D1068392
LAB Type	Physician Office
Facility Name	COMPLETE CARE RURAL HEALTH CLINIC
Street	1911 MISSION 66 STE B
City	VICKSBURG
State	MS
ZIP	39180
Phone	601 665-4162
CertificateType	4
CertificateEffectiveDate	5/9/2023
CertificateExpirationDate	5/8/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024