04D0466251 CLIA NUMBER - BANISTER-LIEBLONG CLINIC

Laboratory Demographics

  • CLIA Code: 04D0466251
  • Facility Name: BANISTER-LIEBLONG CLINIC
  • Facility Address: 2425 DAVE WARD DRIVE, SUITE 401
    CONWAY, AR
    ZIP 72034
  • Facility Phone: 501 329-3824
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: DR. RANDAL G. BOWLIN
  • NPI Number: 1861455057
  • Taxonomy: 261QR1300X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 04D0466251
LAB Type Rural Health Clinic
Facility Name BANISTER-LIEBLONG CLINIC
Street 2425 DAVE WARD DRIVE, SUITE 401
City CONWAY
State AR
ZIP 72034
Phone 501 329-3824
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/29/2024
Certificate Expiration Date 3/28/2026
Facility Type Rural Health Clinic
Lab Director DR. RANDAL G. BOWLIN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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