25D2139800 CLIA NUMBER - VITAL MED, LLC

Laboratory Demographics

  • CLIA Code: 25D2139800
  • Facility Name: VITAL MED, LLC
  • Facility Address: 103 RIDGEMONT VILLA
    BOONEVILLE, MS
    ZIP 38829
  • Facility Phone: 662 200-4151
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: DESIREE B. HAUGH
  • NPI Number: 1710517347
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 25D2139800
LAB Type Practitioner Other
Facility Name VITAL MED, LLC
Street 103 RIDGEMONT VILLA
City BOONEVILLE
State MS
ZIP 38829
Phone 662 200-4151
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2023
Certificate Expiration Date 11/7/2025
Facility Type Practitioner Other
Lab Director DESIREE B. HAUGH

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