04D0941101 CLIA NUMBER - WHITE RIVER HEALTH FAMILY MEDICINE

Laboratory Demographics

  • CLIA Code: 04D0941101
  • Facility Name: WHITE RIVER HEALTH FAMILY MEDICINE
  • Facility Address: 197 HOSPITAL DRIVE SUITE B
    CHEROKEE VILLAGE, AR
    ZIP 72529
  • Facility Phone: 870 257-5118
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: AMANDA DUNAVANT
  • NPI Number: 1114913936
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D0941101
LAB Type Community Clinic
Facility Name WHITE RIVER HEALTH FAMILY MEDICINE
Street 197 HOSPITAL DRIVE SUITE B
City CHEROKEE VILLAGE
State AR
ZIP 72529
Phone 870 257-5118
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2023
Certificate Expiration Date 12/16/2025
Facility Type Community Clinic
Lab Director AMANDA DUNAVANT

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