04D0979586 CLIA NUMBER - SALINE MED PEDS

Laboratory Demographics

  • CLIA Code: 04D0979586
  • Facility Name: SALINE MED PEDS
  • Facility Address: 105 MCNEIL ST
    BENTON, AR
    ZIP 72015
  • Facility Phone: 501 315-1222
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MARK A. MARTINDALE
  • NPI Number: 1396820437
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 04D0979586
LAB Type Physician Office
Facility Name SALINE MED PEDS
Street 105 MCNEIL ST
City BENTON
State AR
ZIP 72015
Phone 501 315-1222
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 4/22/2024
Certificate Expiration Date 4/21/2026
Facility Type Physician Office
Lab Director MARK A. MARTINDALE

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