04D1012185 CLIA NUMBER - MALVERN DIALYSIS

Laboratory Demographics

  • CLIA Code: 04D1012185
  • Facility Name: MALVERN DIALYSIS
  • Facility Address: 1590 TANNER ST
    ROCKPORT, AR
    ZIP 72104
  • Facility Phone: 501 332-3000
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DASARADHA UYYALA
  • NPI Number: 1184042186
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D1012185
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MALVERN DIALYSIS
Street 1590 TANNER ST
City ROCKPORT
State AR
ZIP 72104
Phone 501 332-3000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/3/2025
Certificate Expiration Date 1/2/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DASARADHA UYYALA

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