04D2166077 CLIA NUMBER - HULL DERMATOLOGY

Laboratory Demographics

CLIA Number: 04D2166077

Facility Name: HULL DERMATOLOGY

Facility Address:
9521 SUNSET DR
BELLA VISTA, AR
ZIP 72715
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Facility Phone Number: 479 254-9662

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1407082464

Taxonomy: 261QM2500X - Clinic/Center
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).

CLIA Record

Field Name	Field Value
CLIA Number	04D2166077
LAB Type	Physician Office
Facility Name	HULL DERMATOLOGY
Street	9521 SUNSET DR
City	BELLA VISTA
State	AR
ZIP	72715
Phone	479 254-9662
CertificateType	2
CertificateEffectiveDate	3/19/2024
CertificateExpirationDate	3/18/2026
FacilityType	Compliance

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