04D2172054 CLIA NUMBER - LAVACA WELLNESS CENTER

Laboratory Demographics

  • CLIA Code: 04D2172054
  • Facility Name: LAVACA WELLNESS CENTER
  • Facility Address: 603 S DIVISION ST
    LAVACA, AR
    ZIP 72941
  • Facility Phone: 479 279-7700
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: KELLY HUBBARD
  • NPI Number: 1821390287
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2172054
LAB Type Federally Qualified Health Center
Facility Name LAVACA WELLNESS CENTER
Street 603 S DIVISION ST
City LAVACA
State AR
ZIP 72941
Phone 479 279-7700
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/13/2025
Certificate Expiration Date 9/12/2027
Facility Type Federally Qualified Health Center
Lab Director KELLY HUBBARD

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