04D2140804 CLIA NUMBER - FORT NEURO

Laboratory Demographics

  • CLIA Code: 04D2140804
  • Facility Name: FORT NEURO
  • Facility Address: 9616 ROGERS AVENUE
    FORT SMITH, AR
    ZIP 72903
  • Facility Phone: 479 551-2127
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. TIMOTHY Y. MARYANOV
  • NPI Number: 1932619327
  • Taxonomy: 207T00000X - Neurological Surgery

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CLIA Record

Field Name Field Value
CLIA Number 04D2140804
LAB Type Physician Office
Facility Name FORT NEURO
Street 9616 ROGERS AVENUE
City FORT SMITH
State AR
ZIP 72903
Phone 479 551-2127
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/30/2023
Certificate Expiration Date 11/29/2025
Facility Type Physician Office
Lab Director DR. TIMOTHY Y. MARYANOV

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