04D2112456 CLIA NUMBER - MOUNTAIN HOME OUTPATIENT VA CLINIC

Laboratory Demographics

CLIA Number: 04D2112456

Facility Name: MOUNTAIN HOME OUTPATIENT VA CLINIC

Facility Address:
759 HWY 62 E, STE 331
MOUNTAIN HOME, AR
ZIP 72653
Get Directions

Facility Phone Number: 870 594-8387

Facility Type: Other - VA OUTPATIENT FACILITY

Certificate Type: Waiver

NPI Number: 1467418970

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	04D2112456
LAB Type	Other - VA OUTPATIENT FACILITY
Facility Name	MOUNTAIN HOME OUTPATIENT VA CLINIC
Street	759 HWY 62 E, STE 331
City	MOUNTAIN HOME
State	AR
ZIP	72653
Phone	870 594-8387
CertificateType	4
CertificateEffectiveDate	4/29/2024
CertificateExpirationDate	4/28/2026
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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