04D1011778 CLIA NUMBER - ARKANSAS EXTENDED CARE HOSPITAL - FORT SMITH LHCG CXVIII, LLC

Laboratory Demographics

  • CLIA Code: 04D1011778
  • Facility Name: ARKANSAS EXTENDED CARE HOSPITAL - FORT SMITH LHCG CXVIII, LLC
  • Facility Address: 7301 ROGERS AVENUE, 4TH FLOOR
    FORT SMITH, AR
    ZIP 72903
  • Facility Phone: 479 314-4900
  • Facility Type: Hospital
  • Facility Type: Waiver
  • Lab Director: CHAZ D. HOLDERMAN
  • NPI Number: 1942326244
  • Taxonomy: 152WV0400X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 04D1011778
LAB Type Hospital
Facility Name ARKANSAS EXTENDED CARE HOSPITAL - FORT SMITH LHCG CXVIII, LLC
Street 7301 ROGERS AVENUE, 4TH FLOOR
City FORT SMITH
State AR
ZIP 72903
Phone 479 314-4900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/7/2025
Certificate Expiration Date 7/6/2027
Facility Type Hospital
Lab Director CHAZ D. HOLDERMAN

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