04D0468964 CLIA NUMBER - ST MARY'S REGIONAL MEDICAL CENTER RUSSELLVILLE HOLDINGS LLC

Laboratory Demographics

  • CLIA Code: 04D0468964
  • Facility Name: ST MARY'S REGIONAL MEDICAL CENTER RUSSELLVILLE HOLDINGS LLC
  • Facility Address: 1808 W MAIN STREET
    RUSSELLVILLE, AR
    ZIP 72801
  • Facility Phone: 479 964-9156
  • Facility Type: Hospital
  • Facility Type: Accreditation
  • Lab Director: DR. CHRISTINA A. JETTON
  • NPI Number: 1831730670
  • Taxonomy: 207L00000X - Anesthesiology

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CLIA Record

Field Name Field Value
CLIA Number 04D0468964
LAB Type Hospital
Facility Name ST MARY'S REGIONAL MEDICAL CENTER RUSSELLVILLE HOLDINGS LLC
Street 1808 W MAIN STREET
City RUSSELLVILLE
State AR
ZIP 72801
Phone 479 964-9156
Certificate Type Certificate of Accreditation
Certificate Type Description This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.
Certificate Effective Date 8/17/2025
Certificate Expiration Date 8/16/2027
Facility Type Hospital
Lab Director DR. CHRISTINA A. JETTON

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