04D2173164 CLIA NUMBER - ARCARE 031 PANGBURN MEDICAL

Laboratory Demographics

  • CLIA Code: 04D2173164
  • Facility Name: ARCARE 031 PANGBURN MEDICAL
  • Facility Address: 304 W MAIN
    PANGBURN, AR
    ZIP 72121
  • Facility Phone: 870 919-6696
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Waiver
  • Lab Director: DR. KRISTINE M. PRUITT
  • NPI Number: 1740825363
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2173164
LAB Type Federally Qualified Health Center
Facility Name ARCARE 031 PANGBURN MEDICAL
Street 304 W MAIN
City PANGBURN
State AR
ZIP 72121
Phone 870 919-6696
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/7/2025
Certificate Expiration Date 10/6/2027
Facility Type Federally Qualified Health Center
Lab Director DR. KRISTINE M. PRUITT

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