04D2079796 CLIA NUMBER - ACCESS MEDICAL CLINIC BRADLEY BIBB MD PLLC

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Laboratory Demographics

CLIA Number: 04D2079796

Facility Name: ACCESS MEDICAL CLINIC BRADLEY BIBB MD PLLC

Facility Address:
3519 HWY 63
BLACK ROCK, AR
ZIP 72415
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Facility Phone Number: 870 994-7301

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1437569837

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D2079796
LAB Type	Rural Health Clinic
Facility Name	ACCESS MEDICAL CLINIC BRADLEY BIBB MD PLLC
Street	3519 HWY 63
City	BLACK ROCK
State	AR
ZIP	72415
Phone	870 994-7301
CertificateType	4
CertificateEffectiveDate	6/24/2022
CertificateExpirationDate	6/23/2024
FacilityType	Waiver

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