04D0858683 CLIA NUMBER - PINE BLUFF CLINIC

Laboratory Demographics

  • CLIA Code: 04D0858683
  • Facility Name: PINE BLUFF CLINIC
  • Facility Address: 1101 TENNESSEE STREET
    PINE BLUFF, AR
    ZIP 71601
  • Facility Phone: 870 543-2380
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: DR. MARCUS CROUTHER
  • NPI Number: 1366955346
  • Taxonomy: 1041C0700X - Social Worker

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CLIA Record

Field Name Field Value
CLIA Number 04D0858683
LAB Type Community Clinic
Facility Name PINE BLUFF CLINIC
Street 1101 TENNESSEE STREET
City PINE BLUFF
State AR
ZIP 71601
Phone 870 543-2380
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type Community Clinic
Lab Director DR. MARCUS CROUTHER

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