04D2070901 CLIA NUMBER - DIFFINE FAMILY PRACTICE PLLCC

Laboratory Demographics

  • CLIA Code: 04D2070901
  • Facility Name: DIFFINE FAMILY PRACTICE PLLCC
  • Facility Address: 1100 MEDICAL DRIVE, STE C
    BLYTHEVILLE, AR
    ZIP 72315
  • Facility Phone: 870 824-2809
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. DAVID A. DIFFINE
  • NPI Number: 1962707158
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D2070901
LAB Type Physician Office
Facility Name DIFFINE FAMILY PRACTICE PLLCC
Street 1100 MEDICAL DRIVE, STE C
City BLYTHEVILLE
State AR
ZIP 72315
Phone 870 824-2809
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/30/2023
Certificate Expiration Date 12/29/2025
Facility Type Physician Office
Lab Director DR. DAVID A. DIFFINE

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This page was last updated on: 3/20/2025