04D1107731 CLIA NUMBER - NORTHWEST ARKANSAS UROLOGY ASSOCIATES PLLC

Laboratory Demographics

  • CLIA Code: 04D1107731
  • Facility Name: NORTHWEST ARKANSAS UROLOGY ASSOCIATES PLLC
  • Facility Address: 2000 S 42ND ST SUITE 105
    ROGERS, AR
    ZIP 72756
  • Facility Phone: 479 521-8980
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: CHAD E. BREKELBAUM
  • NPI Number: 1720418213
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 04D1107731
LAB Type Physician Office
Facility Name NORTHWEST ARKANSAS UROLOGY ASSOCIATES PLLC
Street 2000 S 42ND ST SUITE 105
City ROGERS
State AR
ZIP 72756
Phone 479 521-8980
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 11/12/2023
Certificate Expiration Date 11/11/2025
Facility Type Physician Office
Lab Director CHAD E. BREKELBAUM

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