04D2016983 CLIA NUMBER - NORTHWEST FAMILY MEDICINE CENTERTON

Laboratory Demographics

  • CLIA Code: 04D2016983
  • Facility Name: NORTHWEST FAMILY MEDICINE CENTERTON
  • Facility Address: 101 SUN MEADOW DRIVE
    CENTERTON, AR
    ZIP 72719
  • Facility Phone: 479 795-0426
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RANDY CONOVER
  • NPI Number: 1811648751
  • Taxonomy: 1223X0400X - Dentist

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CLIA Record

Field Name Field Value
CLIA Number 04D2016983
LAB Type Physician Office
Facility Name NORTHWEST FAMILY MEDICINE CENTERTON
Street 101 SUN MEADOW DRIVE
City CENTERTON
State AR
ZIP 72719
Phone 479 795-0426
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/1/2024
Certificate Expiration Date 11/30/2026
Facility Type Physician Office
Lab Director RANDY CONOVER

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