04D2059680 CLIA NUMBER - NORTHWEST MEDICAL PLAZA-WEDINGTON

Laboratory Demographics

  • CLIA Code: 04D2059680
  • Facility Name: NORTHWEST MEDICAL PLAZA-WEDINGTON
  • Facility Address: 3399 W BLACK FOREST DRIVE, SUITE 2
    FAYETTEVILLE, AR
    ZIP 72704
  • Facility Phone: 479 757-5056
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. DONNY COKER
  • NPI Number: 1851754345
  • Taxonomy: 207T00000X - Neurological Surgery

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CLIA Record

Field Name Field Value
CLIA Number 04D2059680
LAB Type Physician Office
Facility Name NORTHWEST MEDICAL PLAZA-WEDINGTON
Street 3399 W BLACK FOREST DRIVE, SUITE 2
City FAYETTEVILLE
State AR
ZIP 72704
Phone 479 757-5056
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 10/1/2025
Certificate Expiration Date 9/30/2027
Facility Type Physician Office
Lab Director DR. DONNY COKER

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