04D2093813 CLIA NUMBER - OZARK MEDICAL CLINIC-FAIRFIELD BAY

Laboratory Demographics

  • CLIA Code: 04D2093813
  • Facility Name: OZARK MEDICAL CLINIC-FAIRFIELD BAY
  • Facility Address: 383 DAVE CREEK PARKWAY
    FAIRFIELD BAY, AR
    ZIP 72088
  • Facility Phone: 501 884-6900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. KEITH A. COWARD
  • NPI Number: 1477960581
  • Taxonomy: 261QR1300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2093813
LAB Type Physician Office
Facility Name OZARK MEDICAL CLINIC-FAIRFIELD BAY
Street 383 DAVE CREEK PARKWAY
City FAIRFIELD BAY
State AR
ZIP 72088
Phone 501 884-6900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2025
Certificate Expiration Date 4/5/2027
Facility Type Physician Office
Lab Director DR. KEITH A. COWARD

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