04D1057549 CLIA NUMBER - MAGNOLIA PEDIATRIC CLINIC, INC

Laboratory Demographics

  • CLIA Code: 04D1057549
  • Facility Name: MAGNOLIA PEDIATRIC CLINIC, INC
  • Facility Address: 306 E MCNEIL
    MAGNOLIA, AR
    ZIP 71753
  • Facility Phone: 870 234-5171
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: AMY CROSS
  • NPI Number: 1346248317
  • Taxonomy: 282N00000X - General Acute Care Hospital

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CLIA Record

Field Name Field Value
CLIA Number 04D1057549
LAB Type Physician Office
Facility Name MAGNOLIA PEDIATRIC CLINIC, INC
Street 306 E MCNEIL
City MAGNOLIA
State AR
ZIP 71753
Phone 870 234-5171
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/15/2024
Certificate Expiration Date 8/14/2026
Facility Type Physician Office
Lab Director AMY CROSS

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This page was last updated on: 3/20/2025