04D2166600 CLIA NUMBER - LARISA KACHOWSKI MD, FAMILY MEDICINE PLLC

Laboratory Demographics

  • CLIA Code: 04D2166600
  • Facility Name: LARISA KACHOWSKI MD, FAMILY MEDICINE PLLC
  • Facility Address: 1726 W 42ND AVE
    PINE BLUFF, AR
    ZIP 71603
  • Facility Phone: 870 619-4516
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. LARISA KACHOWSKI
  • NPI Number: 1023214574
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D2166600
LAB Type Physician Office
Facility Name LARISA KACHOWSKI MD, FAMILY MEDICINE PLLC
Street 1726 W 42ND AVE
City PINE BLUFF
State AR
ZIP 71603
Phone 870 619-4516
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2025
Certificate Expiration Date 5/20/2027
Facility Type Physician Office
Lab Director DR. LARISA KACHOWSKI

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