04D2157774 CLIA NUMBER - MAINLINE HEALTH SYSTEMS RISON

Laboratory Demographics

CLIA Number: 04D2157774

Facility Name: MAINLINE HEALTH SYSTEMS RISON

Facility Address:
505 SYCAMORE ST
RISON, AR
ZIP 71665
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Facility Phone Number: 870 325-6255

Facility Type: Federally Qualified Health Center

Certificate Type: Waiver

NPI Number: 1285105957

Taxonomy: 261QF0400X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D2157774
LAB Type	Federally Qualified Health Center
Facility Name	MAINLINE HEALTH SYSTEMS RISON
Street	505 SYCAMORE ST
City	RISON
State	AR
ZIP	71665
Phone	870 325-6255
CertificateType	4
CertificateEffectiveDate	11/13/2022
CertificateExpirationDate	11/12/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024