04D1078542 CLIA NUMBER - HEALTHY CONNECTIONS-MONTGOMERY COMMUNITY CLINIC

Laboratory Demographics

  • CLIA Code: 04D1078542
  • Facility Name: HEALTHY CONNECTIONS-MONTGOMERY COMMUNITY CLINIC
  • Facility Address: 534 LUZERNE STREET
    MOUNT IDA, AR
    ZIP 71957
  • Facility Phone: 888 710-8220
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: DR. SHAWNA M. DEREEMER
  • NPI Number: 1679039127
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D1078542
LAB Type Federally Qualified Health Center
Facility Name HEALTHY CONNECTIONS-MONTGOMERY COMMUNITY CLINIC
Street 534 LUZERNE STREET
City MOUNT IDA
State AR
ZIP 71957
Phone 888 710-8220
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/5/2025
Certificate Expiration Date 5/4/2027
Facility Type Federally Qualified Health Center
Lab Director DR. SHAWNA M. DEREEMER

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