04D2042964 CLIA NUMBER - BAXTER HEALTH FAIRLAMB SENIOR CLINIC

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Laboratory Demographics

CLIA Number: 04D2042964

Facility Name: BAXTER HEALTH FAIRLAMB SENIOR CLINIC

Facility Address:
614 BROADMOOR DR
MOUNTAIN HOME, AR
ZIP 72653
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Facility Phone Number: 870 508-3870

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1437423472

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	04D2042964
LAB Type	Community Clinic
Facility Name	BAXTER HEALTH FAIRLAMB SENIOR CLINIC
Street	614 BROADMOOR DR
City	MOUNTAIN HOME
State	AR
ZIP	72653
Phone	870 508-3870
CertificateType	4
CertificateEffectiveDate	6/25/2022
CertificateExpirationDate	6/24/2024
FacilityType	Waiver

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