04D1061397 CLIA NUMBER - BAXTER HEALTH FAMILY CLINIC AT MAMMOTH SPRING

Laboratory Demographics

  • CLIA Code: 04D1061397
  • Facility Name: BAXTER HEALTH FAMILY CLINIC AT MAMMOTH SPRING
  • Facility Address: 350 SOUTH MAIN SUITE 4
    MAMMOTH SPRING, AR
    ZIP 72554
  • Facility Phone: 870 625-3111
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: CHRISTOPHER WEBB
  • NPI Number: 1619516200
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D1061397
LAB Type Rural Health Clinic
Facility Name BAXTER HEALTH FAMILY CLINIC AT MAMMOTH SPRING
Street 350 SOUTH MAIN SUITE 4
City MAMMOTH SPRING
State AR
ZIP 72554
Phone 870 625-3111
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/16/2024
Certificate Expiration Date 11/15/2026
Facility Type Rural Health Clinic
Lab Director CHRISTOPHER WEBB

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