04D0466333 CLIA NUMBER - COLLEGE STATION CLINIC

Laboratory Demographics

  • CLIA Code: 04D0466333
  • Facility Name: COLLEGE STATION CLINIC
  • Facility Address: 4206 FRAZIER PIKE
    COLLEGE STATION, AR
    ZIP 72053
  • Facility Phone: 501 490-2440
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: DR. MARCUS CROUTHER
  • NPI Number: 1932305737
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D0466333
LAB Type Community Clinic
Facility Name COLLEGE STATION CLINIC
Street 4206 FRAZIER PIKE
City COLLEGE STATION
State AR
ZIP 72053
Phone 501 490-2440
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/4/2025
Certificate Expiration Date 2/3/2027
Facility Type Community Clinic
Lab Director DR. MARCUS CROUTHER

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