04D0465417 CLIA NUMBER - JEFFERSON REGIONAL MONTICELLO MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 04D0465417
  • Facility Name: JEFFERSON REGIONAL MONTICELLO MEDICAL CLINIC
  • Facility Address: 906 ROBERTS DRIVE
    MONTICELLO, AR
    ZIP 71655
  • Facility Phone: 870 367-6867
  • Facility Type: Physician Office
  • Facility Type: Accreditation
  • Lab Director: DR. APRIL WYNNE
  • NPI Number: 1871642215
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D0465417
LAB Type Physician Office
Facility Name JEFFERSON REGIONAL MONTICELLO MEDICAL CLINIC
Street 906 ROBERTS DRIVE
City MONTICELLO
State AR
ZIP 71655
Phone 870 367-6867
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 12/23/2023
Certificate Expiration Date 12/22/2025
Facility Type Physician Office
Lab Director DR. APRIL WYNNE

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