04D1062378 CLIA NUMBER - RVPCS NORTHSIDE CLINIC RIVER VALLEY PRIMARY CARE SERVICES INC

Laboratory Demographics

  • CLIA Code: 04D1062378
  • Facility Name: RVPCS NORTHSIDE CLINIC RIVER VALLEY PRIMARY CARE SERVICES INC
  • Facility Address: 4900 KELLEY HWY
    FORT SMITH, AR
    ZIP 72904
  • Facility Phone: 479 785-5700
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: ZACHARY MCBROOM
  • NPI Number: 1023163193
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D1062378
LAB Type Federally Qualified Health Center
Facility Name RVPCS NORTHSIDE CLINIC RIVER VALLEY PRIMARY CARE SERVICES INC
Street 4900 KELLEY HWY
City FORT SMITH
State AR
ZIP 72904
Phone 479 785-5700
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/27/2024
Certificate Expiration Date 6/26/2026
Facility Type Federally Qualified Health Center
Lab Director ZACHARY MCBROOM

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