04D0466062 CLIA NUMBER - RICH MOUNTAIN WOMEN'S CLINIC

Laboratory Demographics

CLIA Number: 04D0466062

Facility Name: RICH MOUNTAIN WOMEN'S CLINIC

Facility Address:
403A NORTH MORROW
MENA, AR
ZIP 71953
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Facility Phone Number: 479 394-4595

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1861631723

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	04D0466062
LAB Type	Physician Office
Facility Name	RICH MOUNTAIN WOMEN'S CLINIC
Street	403A NORTH MORROW
City	MENA
State	AR
ZIP	71953
Phone	479 394-4595
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