04D1050346 CLIA NUMBER - BAXTER HEALTH PREMIER FAMILY CLINIC

Laboratory Demographics

  • CLIA Code: 04D1050346
  • Facility Name: BAXTER HEALTH PREMIER FAMILY CLINIC
  • Facility Address: 1417 GLADDEN STREET
    HARRISON, AR
    ZIP 72601
  • Facility Phone: 870 741-0016
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: DR. PHILLIP C. JACKSON
  • NPI Number: 1588329056
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 04D1050346
LAB Type Physician Office
Facility Name BAXTER HEALTH PREMIER FAMILY CLINIC
Street 1417 GLADDEN STREET
City HARRISON
State AR
ZIP 72601
Phone 870 741-0016
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 5/14/2025
Certificate Expiration Date 5/13/2027
Facility Type Physician Office
Lab Director DR. PHILLIP C. JACKSON

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