04D1103853 CLIA NUMBER - NOBULLE PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 04D1103853
  • Facility Name: NOBULLE PRIMARY CARE
  • Facility Address: 1000 N COLLEGE AVE
    EL DORADO, AR
    ZIP 71730
  • Facility Phone: 870 881-8008
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ANITA M. BURLESON
  • NPI Number: 1427947738
  • Taxonomy: 363L00000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 04D1103853
LAB Type Physician Office
Facility Name NOBULLE PRIMARY CARE
Street 1000 N COLLEGE AVE
City EL DORADO
State AR
ZIP 71730
Phone 870 881-8008
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 8/19/2025
Certificate Expiration Date 8/18/2027
Facility Type Physician Office
Lab Director ANITA M. BURLESON

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