04D2142818 CLIA NUMBER - WALDRON FAMILY CLINIC

Laboratory Demographics

  • CLIA Code: 04D2142818
  • Facility Name: WALDRON FAMILY CLINIC
  • Facility Address: 2074 RICE ROAD
    WALDRON, AR
    ZIP 72958
  • Facility Phone: 479 635-5300
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: DR. NATHAN H. BENNETT
  • NPI Number: 1992212013
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2142818
LAB Type Federally Qualified Health Center
Facility Name WALDRON FAMILY CLINIC
Street 2074 RICE ROAD
City WALDRON
State AR
ZIP 72958
Phone 479 635-5300
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 1/19/2024
Certificate Expiration Date 1/18/2026
Facility Type Federally Qualified Health Center
Lab Director DR. NATHAN H. BENNETT

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