04D0924888 CLIA NUMBER - MONTICELLO DIALYSIS

Laboratory Demographics

  • CLIA Code: 04D0924888
  • Facility Name: MONTICELLO DIALYSIS
  • Facility Address: 774 JORDAN DRIVE
    MONTICELLO, AR
    ZIP 71655
  • Facility Phone: 501 223-5335
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JAMES CAMPBELL
  • NPI Number: 1710351259
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 04D0924888
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MONTICELLO DIALYSIS
Street 774 JORDAN DRIVE
City MONTICELLO
State AR
ZIP 71655
Phone 501 223-5335
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/10/2025
Certificate Expiration Date 2/9/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director JAMES CAMPBELL

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