04D2011490 CLIA NUMBER - TLC PEDIATRICS, PLLC

Laboratory Demographics

  • CLIA Code: 04D2011490
  • Facility Name: TLC PEDIATRICS, PLLC
  • Facility Address: 955 CAROLYN LANE
    CONWAY, AR
    ZIP 72034
  • Facility Phone: 201 327-2444
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. TERENCE L. CHAMPLIN
  • NPI Number: 1649584038
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 04D2011490
LAB Type Physician Office
Facility Name TLC PEDIATRICS, PLLC
Street 955 CAROLYN LANE
City CONWAY
State AR
ZIP 72034
Phone 201 327-2444
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/17/2024
Certificate Expiration Date 8/16/2026
Facility Type Physician Office
Lab Director DR. TERENCE L. CHAMPLIN

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