04D0465647 CLIA NUMBER - SMACKOVER FAMILY PRACTICE CLINIC

Laboratory Demographics

  • CLIA Code: 04D0465647
  • Facility Name: SMACKOVER FAMILY PRACTICE CLINIC
  • Facility Address: 1400 PERSHING HWY
    SMACKOVER, AR
    ZIP 71762
  • Facility Phone: 870 725-3471
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RICHARD K. DAVIS
  • NPI Number: 1518093459
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 04D0465647
LAB Type Physician Office
Facility Name SMACKOVER FAMILY PRACTICE CLINIC
Street 1400 PERSHING HWY
City SMACKOVER
State AR
ZIP 71762
Phone 870 725-3471
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director RICHARD K. DAVIS

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