04D1093103 CLIA NUMBER - EARLE FAMILY MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 04D1093103
  • Facility Name: EARLE FAMILY MEDICAL CLINIC
  • Facility Address: 1605 SECOND STREET
    EARLE, AR
    ZIP 72331
  • Facility Phone: 870 792-8825
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: SUDESH BANAJI
  • NPI Number: 1639319411
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D1093103
LAB Type Physician Office
Facility Name EARLE FAMILY MEDICAL CLINIC
Street 1605 SECOND STREET
City EARLE
State AR
ZIP 72331
Phone 870 792-8825
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 12/10/2024
Certificate Expiration Date 12/9/2026
Facility Type Physician Office
Lab Director SUDESH BANAJI

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