04D1091249 CLIA NUMBER - WASHINGTON REGIONAL FAMILY CLINIC FAYETTEVILLE WASHINGTON REGIONAL MEDICAL SYSTEM

Laboratory Demographics

  • CLIA Code: 04D1091249
  • Facility Name: WASHINGTON REGIONAL FAMILY CLINIC FAYETTEVILLE WASHINGTON REGIONAL MEDICAL SYSTEM
  • Facility Address: 3 E APPLEBY RD, SUITE 301
    FAYETTEVILLE, AR
    ZIP 72703
  • Facility Phone: 479 463-2000
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. DAVID G. RATCLIFF
  • NPI Number: 1114971819
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D1091249
LAB Type Physician Office
Facility Name WASHINGTON REGIONAL FAMILY CLINIC FAYETTEVILLE WASHINGTON REGIONAL MEDICAL SYSTEM
Street 3 E APPLEBY RD, SUITE 301
City FAYETTEVILLE
State AR
ZIP 72703
Phone 479 463-2000
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 10/28/2024
Certificate Expiration Date 10/27/2026
Facility Type Physician Office
Lab Director DR. DAVID G. RATCLIFF

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