04D1001003 CLIA NUMBER - SPRINGDALE DIALYSIS

Laboratory Demographics

  • CLIA Code: 04D1001003
  • Facility Name: SPRINGDALE DIALYSIS
  • Facility Address: 2070 MCKENZIE RD SUITE B
    SPRINGDALE, AR
    ZIP 72762
  • Facility Phone: 479 750-7056
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SHAMSUL ALAM
  • NPI Number: 1740608744
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D1001003
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name SPRINGDALE DIALYSIS
Street 2070 MCKENZIE RD SUITE B
City SPRINGDALE
State AR
ZIP 72762
Phone 479 750-7056
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/27/2024
Certificate Expiration Date 6/26/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SHAMSUL ALAM

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