04D0971476 CLIA NUMBER - BENTON WOMEN'S CLINIC JOHN V BAKA

Laboratory Demographics

  • CLIA Code: 04D0971476
  • Facility Name: BENTON WOMEN'S CLINIC JOHN V BAKA
  • Facility Address: 1220 MILITARY RD
    BENTON, AR
    ZIP 72015
  • Facility Phone: 501 778-1000
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JOHN V. BAKA
  • NPI Number: 1023033859
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 04D0971476
LAB Type Physician Office
Facility Name BENTON WOMEN'S CLINIC JOHN V BAKA
Street 1220 MILITARY RD
City BENTON
State AR
ZIP 72015
Phone 501 778-1000
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 3/15/2024
Certificate Expiration Date 3/14/2026
Facility Type Physician Office
Lab Director JOHN V. BAKA

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