04D1022158 CLIA NUMBER - EXECUTIVE PARK SURGERY CENTER OF FORT SMITH, INC DBA EXECUTIVE PARK SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 04D1022158
  • Facility Name: EXECUTIVE PARK SURGERY CENTER OF FORT SMITH, INC DBA EXECUTIVE PARK SURGERY CENTER
  • Facility Address: 3314 SOUTH 70TH STREET
    FORT SMITH, AR
    ZIP 72903
  • Facility Phone: 479 424-2744
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: ROSEMARY GRODA
  • NPI Number: 1699736777
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D1022158
LAB Type Ambulatory Surgery Center
Facility Name EXECUTIVE PARK SURGERY CENTER OF FORT SMITH, INC DBA EXECUTIVE PARK SURGERY CENTER
Street 3314 SOUTH 70TH STREET
City FORT SMITH
State AR
ZIP 72903
Phone 479 424-2744
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/9/2024
Certificate Expiration Date 2/8/2026
Facility Type Ambulatory Surgery Center
Lab Director ROSEMARY GRODA

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