04D2046256 CLIA NUMBER - RVPCS EASTSIDE FAMILY CLINIC

Laboratory Demographics

  • CLIA Code: 04D2046256
  • Facility Name: RVPCS EASTSIDE FAMILY CLINIC
  • Facility Address: 4003 MASSARD RD
    FORT SMITH, AR
    ZIP 72903
  • Facility Phone: 479 434-4747
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: DR. KASSANDRA PAYNE
  • NPI Number: 1619232295
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2046256
LAB Type Federally Qualified Health Center
Facility Name RVPCS EASTSIDE FAMILY CLINIC
Street 4003 MASSARD RD
City FORT SMITH
State AR
ZIP 72903
Phone 479 434-4747
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 8/29/2024
Certificate Expiration Date 8/28/2026
Facility Type Federally Qualified Health Center
Lab Director DR. KASSANDRA PAYNE

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