04D1082685 CLIA NUMBER - OZARK MEDICAL CLINIC CLINTON

Laboratory Demographics

CLIA Number: 04D1082685

Facility Name: OZARK MEDICAL CLINIC CLINTON

Facility Address:
390 FACTORY ROAD, SUITE B
CLINTON, AR
ZIP 72031
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Facility Phone Number: 501 745-3388

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1366614935

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D1082685
LAB Type	Physician Office
Facility Name	OZARK MEDICAL CLINIC CLINTON
Street	390 FACTORY ROAD, SUITE B
City	CLINTON
State	AR
ZIP	72031
Phone	501 745-3388
CertificateType	4
CertificateEffectiveDate	11/4/2022
CertificateExpirationDate	11/3/2024
FacilityType	Waiver

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