04D0891058 CLIA NUMBER - MERCY CLINIC FAMILY MEDICINE - GREEN FOREST

Laboratory Demographics

  • CLIA Code: 04D0891058
  • Facility Name: MERCY CLINIC FAMILY MEDICINE - GREEN FOREST
  • Facility Address: 100 MEDICAL CIRCLE
    GREEN FOREST, AR
    ZIP 72638
  • Facility Phone: 870 438-5216
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHARLES HORTON
  • NPI Number: 1053347807
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D0891058
LAB Type Physician Office
Facility Name MERCY CLINIC FAMILY MEDICINE - GREEN FOREST
Street 100 MEDICAL CIRCLE
City GREEN FOREST
State AR
ZIP 72638
Phone 870 438-5216
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/18/2023
Certificate Expiration Date 12/17/2025
Facility Type Physician Office
Lab Director CHARLES HORTON

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