04D2140355 CLIA NUMBER - BAPTIST HEALTH FAMILY CLINIC RUSSELLVILLE

Laboratory Demographics

  • CLIA Code: 04D2140355
  • Facility Name: BAPTIST HEALTH FAMILY CLINIC RUSSELLVILLE
  • Facility Address: 1605 WEST MAIN STREET
    RUSSELLVILLE, AR
    ZIP 72801
  • Facility Phone: 479 219-5008
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. LAVON J. WOOD
  • NPI Number: 1447775192
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D2140355
LAB Type Physician Office
Facility Name BAPTIST HEALTH FAMILY CLINIC RUSSELLVILLE
Street 1605 WEST MAIN STREET
City RUSSELLVILLE
State AR
ZIP 72801
Phone 479 219-5008
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/20/2023
Certificate Expiration Date 11/19/2025
Facility Type Physician Office
Lab Director DR. LAVON J. WOOD

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