04D0466061 CLIA NUMBER - RICH MOUNTAIN FAMILY MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 04D0466061

Facility Name: RICH MOUNTAIN FAMILY MEDICAL CLINIC

Facility Address:
209 N MORROW ST
MENA, AR
ZIP 71953
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Facility Phone Number: 479 394-4703

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1477688554

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D0466061
LAB Type	Physician Office
Facility Name	RICH MOUNTAIN FAMILY MEDICAL CLINIC
Street	209 N MORROW ST
City	MENA
State	AR
ZIP	71953
Phone	479 394-4703
CertificateType	3
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	PPMP

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This page was last updated on: 4/23/2024