04D2043676 CLIA NUMBER - BOSTON MOUNTAIN RURAL HEALTH CENTER, INC

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Laboratory Demographics

CLIA Number: 04D2043676

Facility Name: BOSTON MOUNTAIN RURAL HEALTH CENTER, INC

Facility Address:
358 EAST VALLEY STREET PO BOX 409
YELLVILLE, AR
ZIP 72687
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Facility Phone Number: 870 449-7000

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1487909107

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D2043676
LAB Type	Federally Qualified Health Center
Facility Name	BOSTON MOUNTAIN RURAL HEALTH CENTER, INC
Street	358 EAST VALLEY STREET PO BOX 409
City	YELLVILLE
State	AR
ZIP	72687
Phone	870 449-7000
CertificateType	4
CertificateEffectiveDate	8/29/2022
CertificateExpirationDate	8/28/2024
FacilityType	Waiver

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