04D1062381 CLIA NUMBER - JOHN WHITAKER MD

Laboratory Demographics

  • CLIA Code: 04D1062381
  • Facility Name: JOHN WHITAKER MD
  • Facility Address: 2713 SOUTH 74TH SUITE 408
    FORT SMITH, AR
    ZIP 72903
  • Facility Phone: 479 484-5646
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JOHN C. WHITAKER
  • NPI Number: 1467461764
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 04D1062381
LAB Type Physician Office
Facility Name JOHN WHITAKER MD
Street 2713 SOUTH 74TH SUITE 408
City FORT SMITH
State AR
ZIP 72903
Phone 479 484-5646
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/13/2024
Certificate Expiration Date 12/12/2026
Facility Type Physician Office
Lab Director JOHN C. WHITAKER

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This page was last updated on: 6/4/2025