04D2131666 CLIA NUMBER - DIRECT CARE CLINIC OF NWA INTEGRITAS LLC

Laboratory Demographics

  • CLIA Code: 04D2131666
  • Facility Name: DIRECT CARE CLINIC OF NWA INTEGRITAS LLC
  • Facility Address: 2104 S 54TH STREET STE 4
    ROGERS, AR
    ZIP 72758
  • Facility Phone: 479 268-4504
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JOEL FANKHAUSER
  • NPI Number: 1912392176
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D2131666
LAB Type Physician Office
Facility Name DIRECT CARE CLINIC OF NWA INTEGRITAS LLC
Street 2104 S 54TH STREET STE 4
City ROGERS
State AR
ZIP 72758
Phone 479 268-4504
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/5/2025
Certificate Expiration Date 6/4/2027
Facility Type Physician Office
Lab Director DR. JOEL FANKHAUSER

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