04D0880610 CLIA NUMBER - CHESTER M WYNN MD PA

Laboratory Demographics

CLIA Number: 04D0880610

Facility Name: CHESTER M WYNN MD PA

Facility Address:
118 WEST STADIUM
MAGNOLIA, AR
ZIP 71753
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Facility Phone Number: 870 234-6191

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1699949826

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	04D0880610
LAB Type	Physician Office
Facility Name	CHESTER M WYNN MD PA
Street	118 WEST STADIUM
City	MAGNOLIA
State	AR
ZIP	71753
Phone	870 234-6191
CertificateType	3
CertificateEffectiveDate	12/16/2023
CertificateExpirationDate	12/15/2025
FacilityType	PPMP

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