04D2175893 CLIA NUMBER - CENTRAL ARKANSAS FAMILY CLINIC

Laboratory Demographics

CLIA Number: 04D2175893

Facility Name: CENTRAL ARKANSAS FAMILY CLINIC

Facility Address:
1106 S PINE STREET, STE B
CABOT, AR
ZIP 72023
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Facility Phone Number: 501 422-6373

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1811551336

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	04D2175893
LAB Type	Physician Office
Facility Name	CENTRAL ARKANSAS FAMILY CLINIC
Street	1106 S PINE STREET, STE B
City	CABOT
State	AR
ZIP	72023
Phone	501 422-6373
CertificateType	4
CertificateEffectiveDate	12/4/2023
CertificateExpirationDate	12/3/2025
FacilityType	Waiver

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