CLIA lab
CLIA 25D2108422: Desoto Pediatric Extended Care
Southaven, MS. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 25D2108422 belongs to Desoto Pediatric Extended Care in Southaven, MS.
Certificate of Waiver, effective February 4, 2026, expires February 3, 2028.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Run it in Rivvi
Map your lab's test names to LOINC codes
Open in RivviFree to start. Opens Rivvi, the AI workspace for healthcare teams.
Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- February 4, 2026
- Certificate expiration
- February 3, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- February 4, 2016
- Facility type
- Other
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 25D2108422
- Lab name
- Desoto Pediatric Extended Care
- Address
- 750 Stateline Road, Southaven, MS 38671
- Phone
- (662) 468-1320
- Fax
- (662) 618-6578
Annual test volume the lab reported
- Waived tests
- 50
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Southaven, MS
- All Children's Clinic, PCCertificate of Compliance, Physician office25D2016215
- Arizona UrologyCertificate of Registration, Physician office25D2336844
- Axon Surgical Center, LLCCertificate of Waiver, Ambulatory surgery center25D2344998
- BMG - Desoto Primary Care AssociatesCertificate of Waiver, Physician office25D2046244
- BMG Idtf Mid South Imaging CenterCertificate of Waiver, Ancillary test site25D2269466
- BMG Southaven Family PracticeCertificate of Waiver, Physician office25D2262142
- Balanced Minds and Wellness PLLCCertificate of Waiver, Physician office25D2346667
- Baptist Memorial HospitalCertificate of Accreditation, Hospital25D0316619
- Baptist Memorial Hospital Union Cty - BccdCertificate of Accreditation, Physician office25D0969587
- Baptist Memorial Medical Group, Inc- DWCCertificate of Waiver, Physician office25D2097401
Related
Questions
What is the CLIA number for Desoto Pediatric Extended Care in Southaven?
25D2108422, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Desoto Pediatric Extended Care hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 25D2108422 expire?
The CMS file lists February 3, 2028 as the certificate expiration date; the certificate took effect February 4, 2026.