04D1034084 CLIA NUMBER - SPIRIT MED

Laboratory Demographics

  • CLIA Code: 04D1034084
  • Facility Name: SPIRIT MED
  • Facility Address: 400 FAYETTEVILLE ROAD
    VAN BUREN, AR
    ZIP 72956
  • Facility Phone: 479 474-7771
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: GEORGE H. TOMPKINS
  • NPI Number: 1073689485
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D1034084
LAB Type Physician Office
Facility Name SPIRIT MED
Street 400 FAYETTEVILLE ROAD
City VAN BUREN
State AR
ZIP 72956
Phone 479 474-7771
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 11/23/2024
Certificate Expiration Date 11/22/2026
Facility Type Physician Office
Lab Director GEORGE H. TOMPKINS

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