04D2062950 CLIA NUMBER - COLLOM & CARNEY FAMILY PRACTICE & SENIOR CARE OF A

Laboratory Demographics

  • CLIA Code: 04D2062950
  • Facility Name: COLLOM & CARNEY FAMILY PRACTICE & SENIOR CARE OF A
  • Facility Address: 1307 TRINITY BLVD
    TEXARKANA, AR
    ZIP 71854
  • Facility Phone: 870 773-6467
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. KEVIN OSULLIVAN
  • NPI Number: 1871523480
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2062950
LAB Type Physician Office
Facility Name COLLOM & CARNEY FAMILY PRACTICE & SENIOR CARE OF A
Street 1307 TRINITY BLVD
City TEXARKANA
State AR
ZIP 71854
Phone 870 773-6467
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/24/2025
Certificate Expiration Date 7/23/2027
Facility Type Physician Office
Lab Director DR. KEVIN OSULLIVAN

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