04D2171284 CLIA NUMBER - OZARKS HEALTHCARE - MAMMOTH SPRINGS

Laboratory Demographics

CLIA Number: 04D2171284

Facility Name: OZARKS HEALTHCARE - MAMMOTH SPRINGS

Facility Address:
260 S MAIN ST
MAMMOTH SPRING, AR
ZIP 72554
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Facility Phone Number: 870 625-3228

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1649306002

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D2171284
LAB Type	Rural Health Clinic
Facility Name	OZARKS HEALTHCARE - MAMMOTH SPRINGS
Street	260 S MAIN ST
City	MAMMOTH SPRING
State	AR
ZIP	72554
Phone	870 625-3228
CertificateType	4
CertificateEffectiveDate	8/28/2023
CertificateExpirationDate	8/27/2025
FacilityType	Waiver

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