04D0903055 CLIA NUMBER - SCOTT R NICHOLS MD PA

Laboratory Demographics

  • CLIA Code: 04D0903055
  • Facility Name: SCOTT R NICHOLS MD PA
  • Facility Address: 3801 CAMDEN RD #22
    PINE BLUFF, AR
    ZIP 71603
  • Facility Phone: 870 879-3517
  • Facility Type: Community Clinic
  • Facility Type: Microscopy
  • Lab Director: SCOTT R. NICHOLS MD
  • NPI Number: 1275577280
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D0903055
LAB Type Community Clinic
Facility Name SCOTT R NICHOLS MD PA
Street 3801 CAMDEN RD #22
City PINE BLUFF
State AR
ZIP 71603
Phone 870 879-3517
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 10/14/2024
Certificate Expiration Date 10/13/2026
Facility Type Community Clinic
Lab Director SCOTT R. NICHOLS MD

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