04D0922944 CLIA NUMBER - BENTONVILLE DIALYSIS

Laboratory Demographics

  • CLIA Code: 04D0922944
  • Facility Name: BENTONVILLE DIALYSIS
  • Facility Address: 1104 SE 30TH ST
    BENTONVILLE, AR
    ZIP 72712
  • Facility Phone: 479 657-6220
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. SHAMSUL ALAM
  • NPI Number: 1639597628
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D0922944
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name BENTONVILLE DIALYSIS
Street 1104 SE 30TH ST
City BENTONVILLE
State AR
ZIP 72712
Phone 479 657-6220
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/10/2024
Certificate Expiration Date 12/9/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. SHAMSUL ALAM

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