04D2012289 CLIA NUMBER - ST BERNARDS PHYSICIAN CLINICS, INC

Laboratory Demographics

  • CLIA Code: 04D2012289
  • Facility Name: ST BERNARDS PHYSICIAN CLINICS, INC
  • Facility Address: 800 SOUTH CHURCH STE 302
    JONESBORO, AR
    ZIP 72401
  • Facility Phone: 870 935-3990
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: ANDREW DUNHAM
  • NPI Number: 1013987361
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 04D2012289
LAB Type Physician Office
Facility Name ST BERNARDS PHYSICIAN CLINICS, INC
Street 800 SOUTH CHURCH STE 302
City JONESBORO
State AR
ZIP 72401
Phone 870 935-3990
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 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Physician Office
Lab Director ANDREW DUNHAM

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