04D2079405 CLIA NUMBER - PRIMECARE MEDICAL CLINIC-MCCAIN

Laboratory Demographics

  • CLIA Code: 04D2079405
  • Facility Name: PRIMECARE MEDICAL CLINIC-MCCAIN
  • Facility Address: 2504 MCCAIN BLVD, STE 118
    NORTH LITTLE ROCK, AR
    ZIP 72116
  • Facility Phone: 501 812-6655
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. JOHN P. WORNOCK
  • NPI Number: 1407307788
  • Taxonomy: 261Q00000X - Clinic/Center

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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
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/16/2024
Certificate Expiration Date 6/15/2026
Facility Type Physician Office
Lab Director DR. JOHN P. WORNOCK

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