04D2077869 CLIA NUMBER - MEDEXPRESS URGENT CARE - FAYETTEVILLE

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Laboratory Demographics

CLIA Number: 04D2077869

Facility Name: MEDEXPRESS URGENT CARE - FAYETTEVILLE

Facility Address:
2890 NORTH COLLEGE AVE
FAYETTEVILLE, AR
ZIP 72703
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Facility Phone Number: 479 582-1279

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1578984357

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D2077869
LAB Type	Physician Office
Facility Name	MEDEXPRESS URGENT CARE - FAYETTEVILLE
Street	2890 NORTH COLLEGE AVE
City	FAYETTEVILLE
State	AR
ZIP	72703
Phone	479 582-1279
CertificateType	4
CertificateEffectiveDate	5/16/2024
CertificateExpirationDate	5/15/2026
FacilityType	Waiver

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