04D1002649 CLIA NUMBER - BENTONVILLE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 04D1002649
  • Facility Name: BENTONVILLE PEDIATRICS
  • Facility Address: 2719 SE I ST
    BENTONVILLE, AR
    ZIP 72712
  • Facility Phone: 479 273-5437
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JASON FOSTER
  • NPI Number: 1356319164
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 04D1002649
LAB Type Physician Office
Facility Name BENTONVILLE PEDIATRICS
Street 2719 SE I ST
City BENTONVILLE
State AR
ZIP 72712
Phone 479 273-5437
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2024
Certificate Expiration Date 8/11/2026
Facility Type Physician Office
Lab Director DR. JASON FOSTER

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