04D0939862 CLIA NUMBER - CHI ST VINCENT PRIMARY AND CONVENIENT CARE - KANIS

Laboratory Demographics

  • CLIA Code: 04D0939862
  • Facility Name: CHI ST VINCENT PRIMARY AND CONVENIENT CARE - KANIS
  • Facility Address: 10301 KANIS SUITE 1
    LITTLE ROCK, AR
    ZIP 72205
  • Facility Phone: 501 562-4838
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. SHIVA NALLUR CHANNAKRISHNA
  • NPI Number: 1841326949
  • Taxonomy: 282J00000X - Religious Nonmedical Health Care Institution

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CLIA Record

Field Name Field Value
CLIA Number 04D0939862
LAB Type Physician Office
Facility Name CHI ST VINCENT PRIMARY AND CONVENIENT CARE - KANIS
Street 10301 KANIS SUITE 1
City LITTLE ROCK
State AR
ZIP 72205
Phone 501 562-4838
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 8/21/2024
Certificate Expiration Date 8/20/2026
Facility Type Physician Office
Lab Director DR. SHIVA NALLUR CHANNAKRISHNA

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