04D2107564 CLIA NUMBER - ARKANSAS PEDIATRIC CLINIC

Laboratory Demographics

  • CLIA Code: 04D2107564
  • Facility Name: ARKANSAS PEDIATRIC CLINIC
  • Facility Address: 23157 INTERSTATE 30 S, SUITE 101
    BRYANT, AR
    ZIP 72022
  • Facility Phone: 501 664-4117
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. LORI MONTGOMERY
  • NPI Number: 1093825002
  • Taxonomy: 207X00000X - Orthopaedic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 04D2107564
LAB Type Physician Office
Facility Name ARKANSAS PEDIATRIC CLINIC
Street 23157 INTERSTATE 30 S, SUITE 101
City BRYANT
State AR
ZIP 72022
Phone 501 664-4117
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/15/2024
Certificate Expiration Date 1/14/2026
Facility Type Physician Office
Lab Director DR. LORI MONTGOMERY

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