04D0467679 CLIA NUMBER - PEDIATRIC ASSOCIATES OF WEST MEMPHIS

Laboratory Demographics

  • CLIA Code: 04D0467679
  • Facility Name: PEDIATRIC ASSOCIATES OF WEST MEMPHIS
  • Facility Address: 108 WEST TYLER
    WEST MEMPHIS, AR
    ZIP 72301
  • Facility Phone: 870 732-1191
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. JOHANNA MALLARE
  • NPI Number: 1407966005
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D0467679
LAB Type Physician Office
Facility Name PEDIATRIC ASSOCIATES OF WEST MEMPHIS
Street 108 WEST TYLER
City WEST MEMPHIS
State AR
ZIP 72301
Phone 870 732-1191
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 7/31/2024
Certificate Expiration Date 7/30/2026
Facility Type Physician Office
Lab Director DR. JOHANNA MALLARE

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This page was last updated on: 6/4/2025