04D0468326 CLIA NUMBER - STONE COUNTY FAMILY MEDICINE CLINIC

Laboratory Demographics

CLIA Number: 04D0468326

Facility Name: STONE COUNTY FAMILY MEDICINE CLINIC

Facility Address:
105 CASE COMMONS
MOUNTAIN VIEW, AR
ZIP 72560
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Facility Phone Number: 870 269-4144

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1750860409

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D0468326
LAB Type	Community Clinic
Facility Name	STONE COUNTY FAMILY MEDICINE CLINIC
Street	105 CASE COMMONS
City	MOUNTAIN VIEW
State	AR
ZIP	72560
Phone	870 269-4144
CertificateType	4
CertificateEffectiveDate	8/5/2022
CertificateExpirationDate	8/4/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024