04D0642342 CLIA NUMBER - MOUNTAIN HOME SURGERY CENTER, INC

Laboratory Demographics

  • CLIA Code: 04D0642342
  • Facility Name: MOUNTAIN HOME SURGERY CENTER, INC
  • Facility Address: 360 HWY 5 NORTH
    MOUNTAIN HOME, AR
    ZIP 72653
  • Facility Phone: 870 425-2277
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: KENNETH A. JONES
  • NPI Number: 1497029466
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D0642342
LAB Type Ambulatory Surgery Center
Facility Name MOUNTAIN HOME SURGERY CENTER, INC
Street 360 HWY 5 NORTH
City MOUNTAIN HOME
State AR
ZIP 72653
Phone 870 425-2277
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Ambulatory Surgery Center
Lab Director KENNETH A. JONES

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