04D1026632 CLIA NUMBER - PEDIATRIC PARTNERS

Laboratory Demographics

  • CLIA Code: 04D1026632
  • Facility Name: PEDIATRIC PARTNERS
  • Facility Address: 7303 ROGERS AVENUE SUITE 201
    FORT SMITH, AR
    ZIP 72903
  • Facility Phone: 479 478-7200
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JON R. HENDRICKSON
  • NPI Number: 1932168606
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 04D1026632
LAB Type Physician Office
Facility Name PEDIATRIC PARTNERS
Street 7303 ROGERS AVENUE SUITE 201
City FORT SMITH
State AR
ZIP 72903
Phone 479 478-7200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/10/2024
Certificate Expiration Date 6/9/2026
Facility Type Physician Office
Lab Director JON R. HENDRICKSON

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