04D2113940 CLIA NUMBER - RIVER VALLEY DRUG TESTING AND SUPPLIES LLC

Laboratory Demographics

  • CLIA Code: 04D2113940
  • Facility Name: RIVER VALLEY DRUG TESTING AND SUPPLIES LLC
  • Facility Address: 1410 W MAIN
    RUSSELLVILLE, AR
    ZIP 72801
  • Facility Phone: 479 435-7220
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: JESSICA L. CARR
  • NPI Number: 1285300459
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2113940
LAB Type Practitioner Other
Facility Name RIVER VALLEY DRUG TESTING AND SUPPLIES LLC
Street 1410 W MAIN
City RUSSELLVILLE
State AR
ZIP 72801
Phone 479 435-7220
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/3/2024
Certificate Expiration Date 6/2/2026
Facility Type Practitioner Other
Lab Director JESSICA L. CARR

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This page was last updated on: 6/4/2025