04D2079405 CLIA NUMBER - PRIMECARE MEDICAL CLINIC-MCCAIN

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Laboratory Demographics

CLIA Number: 04D2079405

Facility Name: PRIMECARE MEDICAL CLINIC-MCCAIN

Facility Address:
2504 MCCAIN BLVD, STE 118
NORTH LITTLE ROCK, AR
ZIP 72116
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Facility Phone Number: 501 812-6655

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1407307788

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	04D2079405
LAB Type	Physician Office
Facility Name	PRIMECARE MEDICAL CLINIC-MCCAIN
Street	2504 MCCAIN BLVD, STE 118
City	NORTH LITTLE ROCK
State	AR
ZIP	72116
Phone	501 812-6655
CertificateType	3
CertificateEffectiveDate	6/16/2022
CertificateExpirationDate	6/15/2024
FacilityType	PPMP

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