04D1006158 CLIA NUMBER - INTERNAL MEDICINE OF FORREST CITY

Laboratory Demographics

  • CLIA Code: 04D1006158
  • Facility Name: INTERNAL MEDICINE OF FORREST CITY
  • Facility Address: 332 EAST COOK ST
    FORREST CITY, AR
    ZIP 72335
  • Facility Phone: 870 630-2233
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: SUDESH BANAJI
  • NPI Number: 1659455830
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D1006158
LAB Type Physician Office
Facility Name INTERNAL MEDICINE OF FORREST CITY
Street 332 EAST COOK ST
City FORREST CITY
State AR
ZIP 72335
Phone 870 630-2233
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 11/8/2024
Certificate Expiration Date 11/7/2026
Facility Type Physician Office
Lab Director SUDESH BANAJI

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