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

Laboratory Demographics

  • CLIA Code: 04D2079796
  • Facility Name: ACCESS MEDICAL CLINIC BRADLEY BIBB MD PLLC
  • Facility Address: 3519 HWY 63
    BLACK ROCK, AR
    ZIP 72415
  • Facility Phone: 870 878-4005
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: DR. MARK HAHN
  • NPI Number: 1437569837
  • Taxonomy: 261QR1300X - Clinic/Center

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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 870 878-4005
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/24/2024
Certificate Expiration Date 6/23/2026
Facility Type Rural Health Clinic
Lab Director DR. MARK HAHN

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