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25D2119476 CLIA NUMBER - SOUTHERN HEALTH NETWORK CITY OF VICKSBURG CLINIC

Laboratory Demographics

CLIA Number: 25D2119476

Facility Name: SOUTHERN HEALTH NETWORK CITY OF VICKSBURG CLINIC

Facility Address:
1911 MISSION 66 STE C
VICKSBURG, MS
ZIP 39180
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Facility Phone Number: 601 714-1404

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1225571698

Taxonomy: 207R00000X - Internal Medicine
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

CLIA Record

Field Name Field Value
CLIA Number 25D2119476
LAB Type Physician Office
Facility Name SOUTHERN HEALTH NETWORK CITY OF VICKSBURG CLINIC
Street 1911 MISSION 66 STE C
City VICKSBURG
State MS
ZIP 39180
Phone 601 714-1404
CertificateType 4
CertificateEffectiveDate 9/27/2022
CertificateExpirationDate 9/26/2024
FacilityType Waiver

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