04D0678168 CLIA NUMBER - DREW MEMORIAL HOSPITAL HOME HEALTH AGENCY

Laboratory Demographics

  • CLIA Code: 04D0678168
  • Facility Name: DREW MEMORIAL HOSPITAL HOME HEALTH AGENCY
  • Facility Address: 778 SCOGIN DRIVE
    MONTICELLO, AR
    ZIP 71655
  • Facility Phone: 870 367-2411
  • Facility Type: Home Health Agency
  • Facility Type: Waiver
  • Lab Director: KARON BEAVERS
  • NPI Number: 1124074430
  • Taxonomy: 367500000X - Nurse Anesthetist, Certified Registered

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CLIA Record

Field Name Field Value
CLIA Number 04D0678168
LAB Type Home Health Agency
Facility Name DREW MEMORIAL HOSPITAL HOME HEALTH AGENCY
Street 778 SCOGIN DRIVE
City MONTICELLO
State AR
ZIP 71655
Phone 870 367-2411
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 Home Health Agency
Lab Director KARON BEAVERS

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