04D0970176 CLIA NUMBER - CLARKSVILLE FAMILY MEDICAL CENTER

Laboratory Demographics

  • CLIA Code: 04D0970176
  • Facility Name: CLARKSVILLE FAMILY MEDICAL CENTER
  • Facility Address: 25 PROFESSIONAL PARK DR
    CLARKSVILLE, AR
    ZIP 72830
  • Facility Phone: 479 705-8181
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: BOBBY R. NOONAN
  • NPI Number: 1477512127
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D0970176
LAB Type Physician Office
Facility Name CLARKSVILLE FAMILY MEDICAL CENTER
Street 25 PROFESSIONAL PARK DR
City CLARKSVILLE
State AR
ZIP 72830
Phone 479 705-8181
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 2/4/2024
Certificate Expiration Date 2/3/2026
Facility Type Physician Office
Lab Director BOBBY R. NOONAN

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