04D0922946 CLIA NUMBER - FAYETTEVILLE DIALYSIS

Laboratory Demographics

  • CLIA Code: 04D0922946
  • Facility Name: FAYETTEVILLE DIALYSIS
  • Facility Address: 509 E MILLSAP RD, STE 111
    FAYETTEVILLE, AR
    ZIP 72703
  • Facility Phone: 479 443-6688
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SHAMSUL L. ALAM
  • NPI Number: 1811315971
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D0922946
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name FAYETTEVILLE DIALYSIS
Street 509 E MILLSAP RD, STE 111
City FAYETTEVILLE
State AR
ZIP 72703
Phone 479 443-6688
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 SHAMSUL L. ALAM

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