04D1038340 CLIA NUMBER - PARAGOULD US RENAL CARE US RENAL CARE OF NORTHEAST ARKANSAS

Laboratory Demographics

CLIA Number: 04D1038340

Facility Name: PARAGOULD US RENAL CARE US RENAL CARE OF NORTHEAST ARKANSAS

Facility Address:
901 W KINGSHIGHWAY
PARAGOULD, AR
ZIP 72450
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Facility Phone Number: 870 215-0187

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1295712131

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D1038340
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	PARAGOULD US RENAL CARE US RENAL CARE OF NORTHEAST ARKANSAS
Street	901 W KINGSHIGHWAY
City	PARAGOULD
State	AR
ZIP	72450
Phone	870 215-0187
CertificateType	4
CertificateEffectiveDate	3/16/2023
CertificateExpirationDate	3/15/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024