04D2168363 CLIA NUMBER - ARKANSAS-UROLOGY-BENTONVILLE

Laboratory Demographics

  • CLIA Code: 04D2168363
  • Facility Name: ARKANSAS-UROLOGY-BENTONVILLE
  • Facility Address: 3400 SE MACY ROAD
    BENTONVILLE, AR
    ZIP 72712
  • Facility Phone: 201 519-8900
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. MICHAEL A. CHILDS
  • NPI Number: 1275561516
  • Taxonomy: 174400000X - Specialist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 04D2168363
LAB Type Physician Office
Facility Name ARKANSAS-UROLOGY-BENTONVILLE
Street 3400 SE MACY ROAD
City BENTONVILLE
State AR
ZIP 72712
Phone 201 519-8900
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/27/2023
Certificate Expiration Date 6/26/2025
Facility Type Physician Office
Lab Director DR. MICHAEL A. CHILDS

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