04D0934300 CLIA NUMBER - SOUTHWEST ARKANSAS DIALYSIS

Laboratory Demographics

  • CLIA Code: 04D0934300
  • Facility Name: SOUTHWEST ARKANSAS DIALYSIS
  • Facility Address: 405 N FREDRICK STREET
    MAGNOLIA, AR
    ZIP 71753
  • Facility Phone: 870 626-3004
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. JOHN O. STEVENS
  • NPI Number: 1902177181
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D0934300
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name SOUTHWEST ARKANSAS DIALYSIS
Street 405 N FREDRICK STREET
City MAGNOLIA
State AR
ZIP 71753
Phone 870 626-3004
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2025
Certificate Expiration Date 10/2/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. JOHN O. STEVENS

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