04D2155020 CLIA NUMBER - PROACTIVE HEART AND VASCULAR, PLLC

Laboratory Demographics

  • CLIA Code: 04D2155020
  • Facility Name: PROACTIVE HEART AND VASCULAR, PLLC
  • Facility Address: 1229 AR-77 #1
    MARION, AR
    ZIP 72364
  • Facility Phone: 901 297-4000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MICHAEL A. NELSON
  • NPI Number: 1700973625
  • Taxonomy: 207RC0000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 04D2155020
LAB Type Physician Office
Facility Name PROACTIVE HEART AND VASCULAR, PLLC
Street 1229 AR-77 #1
City MARION
State AR
ZIP 72364
Phone 901 297-4000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/21/2024
Certificate Expiration Date 9/20/2026
Facility Type Physician Office
Lab Director DR. MICHAEL A. NELSON

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

This page was last updated on: 3/20/2025