04D0889292 CLIA NUMBER - MOUNTAINBURG FAMILY CLINIC RIVER VALLEY PRIMARY CARE SERVICES, INC.

Laboratory Demographics

CLIA Number: 04D0889292

Facility Name: MOUNTAINBURG FAMILY CLINIC RIVER VALLEY PRIMARY CARE SERVICES, INC.

Facility Address:
4 HIGHWAY 71 NORTHEAST
MOUNTAINBURG, AR
ZIP 72946
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Facility Phone Number: 479 369-2091

Facility Type: Federally Qualified Health Center

Certificate Type: Microscopy

NPI Number: 1568471571

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D0889292
LAB Type	Federally Qualified Health Center
Facility Name	MOUNTAINBURG FAMILY CLINIC RIVER VALLEY PRIMARY CARE SERVICES, INC.
Street	4 HIGHWAY 71 NORTHEAST
City	MOUNTAINBURG
State	AR
ZIP	72946
Phone	479 369-2091
CertificateType	3
CertificateEffectiveDate	9/24/2023
CertificateExpirationDate	9/23/2025
FacilityType	PPMP

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