04D1061469 CLIA NUMBER - RIVER VALLEY CHRISTIAN CLINIC

Laboratory Demographics

CLIA Number: 04D1061469

Facility Name: RIVER VALLEY CHRISTIAN CLINIC

Facility Address:
3001 E H STREET SUITE A
RUSSELLVILLE, AR
ZIP 72812
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Facility Phone Number: 479 229-2566

Facility Type: Other

Certificate Type: Microscopy

NPI Number: 1245437490

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D1061469
LAB Type	Other
Facility Name	RIVER VALLEY CHRISTIAN CLINIC
Street	3001 E H STREET SUITE A
City	RUSSELLVILLE
State	AR
ZIP	72812
Phone	479 229-2566
CertificateType	3
CertificateEffectiveDate	11/17/2022
CertificateExpirationDate	11/16/2024
FacilityType	PPMP

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