04D0467474 CLIA NUMBER - OFFICE PARK FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 04D0467474
  • Facility Name: OFFICE PARK FAMILY PRACTICE
  • Facility Address: 1415 BRECKENRIDGE DRIVE
    LITTLE ROCK, AR
    ZIP 72227
  • Facility Phone: 501 225-9222
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ELWYN J. PERSER
  • NPI Number: 1396854642
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D0467474
LAB Type Physician Office
Facility Name OFFICE PARK FAMILY PRACTICE
Street 1415 BRECKENRIDGE DRIVE
City LITTLE ROCK
State AR
ZIP 72227
Phone 501 225-9222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/12/2024
Certificate Expiration Date 12/11/2026
Facility Type Physician Office
Lab Director ELWYN J. PERSER

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