04D0955996 CLIA NUMBER - JACKSON COUNTY DIALYSIS

Laboratory Demographics

  • CLIA Code: 04D0955996
  • Facility Name: JACKSON COUNTY DIALYSIS
  • Facility Address: 1912 MCLAIN ST
    NEWPORT, AR
    ZIP 72112
  • Facility Phone: 870 523-2607
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. GREGORY MOCK
  • NPI Number: 1871898965
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D0955996
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name JACKSON COUNTY DIALYSIS
Street 1912 MCLAIN ST
City NEWPORT
State AR
ZIP 72112
Phone 870 523-2607
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/15/2025
Certificate Expiration Date 1/14/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. GREGORY MOCK

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