1. Home
  2. Directory
  3. Mississippi
  4. Booneville
  5. Clinic Center
  6. NPI Profile

VITAL MED LLC
NPI 1710517347
Clinic/Center - Primary Care in Booneville, MS

Active since January 23, 2020CLIA 25D2139800 · Waiver
103 RIDGEMONT VILLA, BOONEVILLE, MS 38829(662) 368-3858(662) 368-3931 Get Directions Write a Review

NPPES record last updated: January 23, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Vital Med Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

VITAL MED LLC (NPI 1710517347) is a healthcare organization registered as a primary care in Booneville, Mississippi and active in the NPI registry since January 2020. The organization holds a CLIA Waiver certificate valid through November 7, 2027 and lists Desiree Brooke Haugh, Owner/np, as its authorized official.

NPPES Registry Identity

NPI1710517347
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business NameVITAL MED LLC
Location Address103 RIDGEMONT VILLABooneville, MS 38829-1010
Mailing Address103 Ridgemont VillaBooneville, MS 38829-1010 · (662) 368-3858 · Fax (662) 368-3931
Phone(662) 368-3858
Fax(662) 368-3931
Organization SubpartNo
Authorized OfficialDesiree Brooke HaughOwner/np · (662) 368-3858
Enumeration DateJanuary 23, 2020
✔ NPI 1710517347 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
103 RIDGEMONT VILLA, Booneville, MS 38829
Open in Google Maps ↗

Other Identifiers 1

Medicaid02056754MS

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D2139800

Vital Med, LLC · Booneville, MS
Active · expires Nov 7, 2027
CLIA Number25D2139800
Laboratory TypePractitioner Other
Certificate Effective DateNovember 8, 2025
Certificate Expiration DateNovember 7, 2027
Laboratory DirectorDesiree B. Haugh
Laboratory Phone(662) 200-4151
Laboratory LocationVital Med, LLC103 Ridgemont Villa, Booneville, MS 38829
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DESIREE BROOKE HAUGH NP-C
Nurse Practitioner (Family)
103 RIDGEMONT VILLA
BOONEVILLE, MS 38829
Prentiss County (662) 368-3858

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Vital Med LLC's NPI number?

The NPI number for Vital Med LLC is 1710517347. It was assigned to this organization in the NPPES registry on January 23, 2020.

Where is Vital Med LLC located?

Vital Med LLC is located at 103 Ridgemont Villa, Booneville, MS 38829. The listed phone number is (662) 368-3858.

What is Vital Med LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does Vital Med LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2139800) is associated with this NPI, valid through November 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Vital Med LLC was last updated on January 23, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.