04D2071136 CLIA NUMBER - MARION MINOR MEDICAL

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Laboratory Demographics

CLIA Number: 04D2071136

Facility Name: MARION MINOR MEDICAL

Facility Address:
136 BLOCK ST
MARION, AR
ZIP 72364
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Facility Phone Number: 870 559-2314

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1962823310

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	04D2071136
LAB Type	Physician Office
Facility Name	MARION MINOR MEDICAL
Street	136 BLOCK ST
City	MARION
State	AR
ZIP	72364
Phone	870 559-2314
CertificateType	4
CertificateEffectiveDate	1/3/2024
CertificateExpirationDate	1/2/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024