04D2010489 CLIA NUMBER - BONO FAMILY MEDICAL CLINIC AND THERAPY SERVICES NEA RELIANT HEALTHCARE PROFESSIONALS, INC

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Laboratory Demographics

CLIA Number: 04D2010489

Facility Name: BONO FAMILY MEDICAL CLINIC AND THERAPY SERVICES NEA RELIANT HEALTHCARE PROFESSIONALS, INC

Facility Address:
9146 HWY 63 N
BONO, AR
ZIP 72416
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Facility Phone Number: 870 930-9990

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1467829804

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	04D2010489
LAB Type	Practitioner Other
Facility Name	BONO FAMILY MEDICAL CLINIC AND THERAPY SERVICES NEA RELIANT HEALTHCARE PROFESSIONALS, INC
Street	9146 HWY 63 N
City	BONO
State	AR
ZIP	72416
Phone	870 930-9990
CertificateType	4
CertificateEffectiveDate	10/1/2022
CertificateExpirationDate	9/30/2024
FacilityType	Waiver

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