04D2061591 CLIA NUMBER - FORE FAMILY PRACTICE LLC

Laboratory Demographics

  • CLIA Code: 04D2061591
  • Facility Name: FORE FAMILY PRACTICE LLC
  • Facility Address: 307 N MAIN ST
    CAVE CITY, AR
    ZIP 72521
  • Facility Phone: 870 283-5550
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: DR. TERRY BURNS
  • NPI Number: 1174961239
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2061591
LAB Type Rural Health Clinic
Facility Name FORE FAMILY PRACTICE LLC
Street 307 N MAIN ST
City CAVE CITY
State AR
ZIP 72521
Phone 870 283-5550
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/1/2025
Certificate Expiration Date 6/30/2027
Facility Type Rural Health Clinic
Lab Director DR. TERRY BURNS

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