04D2096442 CLIA NUMBER - BRAY FAMILY MEDICINE, PLLC

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Laboratory Demographics

CLIA Number: 04D2096442

Facility Name: BRAY FAMILY MEDICINE, PLLC

Facility Address:
303 PROFESSIONAL PARK DRIVE
ARKADELPHIA, AR
ZIP 71923
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Facility Phone Number: 000 870-4641

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1528459369

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D2096442
LAB Type	Physician Office
Facility Name	BRAY FAMILY MEDICINE, PLLC
Street	303 PROFESSIONAL PARK DRIVE
City	ARKADELPHIA
State	AR
ZIP	71923
Phone	000 870-4641
CertificateType	3
CertificateEffectiveDate	5/26/2023
CertificateExpirationDate	5/25/2025
FacilityType	PPMP

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