04D0961744 CLIA NUMBER - INDEPENDENCE COUNTY DIALYSIS

Laboratory Demographics

  • CLIA Code: 04D0961744
  • Facility Name: INDEPENDENCE COUNTY DIALYSIS
  • Facility Address: 1700 HARRISON STREET, SUITE F
    BATESVILLE, AR
    ZIP 72501
  • Facility Phone: 870 793-8058
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: ALEX S. DAVIS
  • NPI Number: 1689979775
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D0961744
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name INDEPENDENCE COUNTY DIALYSIS
Street 1700 HARRISON STREET, SUITE F
City BATESVILLE
State AR
ZIP 72501
Phone 870 793-8058
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/15/2025
Certificate Expiration Date 6/14/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director ALEX S. DAVIS

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