04D1091251 CLIA NUMBER - WASHINGTON REG CLINIC SENIOR HEALTH WASHINGTON REGIONAL MEDICAL SYSTEM

Laboratory Demographics

CLIA Number: 04D1091251

Facility Name: WASHINGTON REG CLINIC SENIOR HEALTH WASHINGTON REGIONAL MEDICAL SYSTEM

Facility Address:
12 E APPLEBY SUITE 101
FAYETTEVILLE, AR
ZIP 72703
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Facility Phone Number: 479 463-4444

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1699731208

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D1091251
LAB Type	Physician Office
Facility Name	WASHINGTON REG CLINIC SENIOR HEALTH WASHINGTON REGIONAL MEDICAL SYSTEM
Street	12 E APPLEBY SUITE 101
City	FAYETTEVILLE
State	AR
ZIP	72703
Phone	479 463-4444
CertificateType	3
CertificateEffectiveDate	10/28/2022
CertificateExpirationDate	10/27/2024
FacilityType	PPMP

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