04D1068870 CLIA NUMBER - JACKSONVILLE CENTRAL DIALYSIS CENTER

Laboratory Demographics

  • CLIA Code: 04D1068870
  • Facility Name: JACKSONVILLE CENTRAL DIALYSIS CENTER
  • Facility Address: 400 T P WHITE DRIVE
    JACKSONVILLE, AR
    ZIP 72076
  • Facility Phone: 501 241-1300
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. FAKHAR IJAZ
  • NPI Number: 1881140648
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 04D1068870
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name JACKSONVILLE CENTRAL DIALYSIS CENTER
Street 400 T P WHITE DRIVE
City JACKSONVILLE
State AR
ZIP 72076
Phone 501 241-1300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/22/2025
Certificate Expiration Date 5/21/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. FAKHAR IJAZ

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