04D2119654 CLIA NUMBER - GREAT RIVER FAMILY CLINIC

Laboratory Demographics

  • CLIA Code: 04D2119654
  • Facility Name: GREAT RIVER FAMILY CLINIC
  • Facility Address: 1522 N DIVISION ST
    BLYTHEVILLE, AR
    ZIP 72315
  • Facility Phone: 870 838-7530
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. CHIMERE ASHLEY HAMMETT
  • NPI Number: 1467586131
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 04D2119654
LAB Type Physician Office
Facility Name GREAT RIVER FAMILY CLINIC
Street 1522 N DIVISION ST
City BLYTHEVILLE
State AR
ZIP 72315
Phone 870 838-7530
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/30/2024
Certificate Expiration Date 9/29/2026
Facility Type Physician Office
Lab Director DR. CHIMERE ASHLEY HAMMETT

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