04D0468992 CLIA NUMBER - PATHOLOGY SERVICES LABORATORY PA

Laboratory Demographics

  • CLIA Code: 04D0468992
  • Facility Name: PATHOLOGY SERVICES LABORATORY PA
  • Facility Address: 1430 WEST C STREET
    RUSSELLVILLE, AR
    ZIP 72801
  • Facility Phone: 479 968-6781
  • Facility Type: Independent
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. CHRISTINA A. JETTON
  • NPI Number: 1093889347
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 04D0468992
LAB Type Independent
Facility Name PATHOLOGY SERVICES LABORATORY PA
Street 1430 WEST C STREET
City RUSSELLVILLE
State AR
ZIP 72801
Phone 479 968-6781
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 5/19/2025
Certificate Expiration Date 5/18/2027
Facility Type Independent
Lab Director DR. CHRISTINA A. JETTON

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