04D0698656 CLIA NUMBER - JEFFERSON REGIONAL HEALTHWORKS

Laboratory Demographics

CLIA Number: 04D0698656

Facility Name: JEFFERSON REGIONAL HEALTHWORKS

Facility Address:
4201 S MULBERRY STREET
PINE BLUFF, AR
ZIP 71603
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Facility Phone Number: 870 536-6600

Facility Type: Industrial

Certificate Type: Waiver

NPI Number: 1841235868

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	04D0698656
LAB Type	Industrial
Facility Name	JEFFERSON REGIONAL HEALTHWORKS
Street	4201 S MULBERRY STREET
City	PINE BLUFF
State	AR
ZIP	71603
Phone	870 536-6600
CertificateType	4
CertificateEffectiveDate	12/1/2023
CertificateExpirationDate	11/30/2025
FacilityType	Waiver

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