04D0466144 CLIA NUMBER - SALINE MEDICAL GROUP

Laboratory Demographics

  • CLIA Code: 04D0466144
  • Facility Name: SALINE MEDICAL GROUP
  • Facility Address: 624 ALCOA ROAD
    BENTON, AR
    ZIP 72015
  • Facility Phone: 501 315-4512
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROGER L. TILLEY
  • NPI Number: 1700830718
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D0466144
LAB Type Physician Office
Facility Name SALINE MEDICAL GROUP
Street 624 ALCOA ROAD
City BENTON
State AR
ZIP 72015
Phone 501 315-4512
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/21/2024
Certificate Expiration Date 10/20/2026
Facility Type Physician Office
Lab Director ROGER L. TILLEY

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