04D2065008 CLIA NUMBER - MISSISSIPPI COUNTY PRIMARY CARE PHYSICIANS

Laboratory Demographics

  • CLIA Code: 04D2065008
  • Facility Name: MISSISSIPPI COUNTY PRIMARY CARE PHYSICIANS
  • Facility Address: 602 WEST UNION, SUITE B
    OSCEOLA, AR
    ZIP 72370
  • Facility Phone: 870 563-6504
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PRATAPJI THAKOR
  • NPI Number: 1609246370
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 04D2065008
LAB Type Physician Office
Facility Name MISSISSIPPI COUNTY PRIMARY CARE PHYSICIANS
Street 602 WEST UNION, SUITE B
City OSCEOLA
State AR
ZIP 72370
Phone 870 563-6504
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/30/2025
Certificate Expiration Date 8/29/2027
Facility Type Physician Office
Lab Director PRATAPJI THAKOR

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