04D2172038 CLIA NUMBER - WHITES FAMILY CLINIC

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Laboratory Demographics

CLIA Number: 04D2172038

Facility Name: WHITES FAMILY CLINIC

Facility Address:
418 NORTH 2ND ST
ASHDOWN, AR
ZIP 71822
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Facility Phone Number: 870 898-0002

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1548816044

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	04D2172038
LAB Type	Physician Office
Facility Name	WHITES FAMILY CLINIC
Street	418 NORTH 2ND ST
City	ASHDOWN
State	AR
ZIP	71822
Phone	870 898-0002
CertificateType	4
CertificateEffectiveDate	9/13/2023
CertificateExpirationDate	9/12/2025
FacilityType	Waiver

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