04D2126501 CLIA NUMBER - MAINLINE EUDORA SCHOOL BASED CLINIC

Laboratory Demographics

  • CLIA Code: 04D2126501
  • Facility Name: MAINLINE EUDORA SCHOOL BASED CLINIC
  • Facility Address: 566 MABRY ST
    EUDORA, AR
    ZIP 71640
  • Facility Phone: 870 538-5414
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: DR. JAMIE EVANS
  • NPI Number: 1619415460
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2126501
LAB Type Federally Qualified Health Center
Facility Name MAINLINE EUDORA SCHOOL BASED CLINIC
Street 566 MABRY ST
City EUDORA
State AR
ZIP 71640
Phone 870 538-5414
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/28/2025
Certificate Expiration Date 2/27/2027
Facility Type Federally Qualified Health Center
Lab Director DR. JAMIE EVANS

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