04D2142136 CLIA NUMBER - LAKESIDE HIGH SCHOOL BASED CLINIC MAINLINE HEALTH SYSTEMS, INC

Laboratory Demographics

  • CLIA Code: 04D2142136
  • Facility Name: LAKESIDE HIGH SCHOOL BASED CLINIC MAINLINE HEALTH SYSTEMS, INC
  • Facility Address: 336 W HIGHWAY 82
    LAKE VILLAGE, AR
    ZIP 71653
  • Facility Phone: 870 538-5414
  • Facility Type: School/Student Health Service
  • Facility Type: Waiver
  • Lab Director: DR. JAMIE EVANS
  • NPI Number: 1508303124
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2142136
LAB Type School/Student Health Service
Facility Name LAKESIDE HIGH SCHOOL BASED CLINIC MAINLINE HEALTH SYSTEMS, INC
Street 336 W HIGHWAY 82
City LAKE VILLAGE
State AR
ZIP 71653
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 1/4/2024
Certificate Expiration Date 1/3/2026
Facility Type School/Student Health Service
Lab Director DR. JAMIE EVANS

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