04D2176842 CLIA NUMBER - JEFFERSON REGIONAL MONTICELLO MEDICAL CLINIC 2

Laboratory Demographics

  • CLIA Code: 04D2176842
  • Facility Name: JEFFERSON REGIONAL MONTICELLO MEDICAL CLINIC 2
  • Facility Address: 733 ROBERTS DRIVE
    MONTICELLO, AR
    ZIP 71655
  • Facility Phone: 870 460-4766
  • Facility Type: Rural Health Clinic
  • Facility Type: Waiver
  • Lab Director: MS. APRIL WYNNE
  • NPI Number: 1396954228
  • Taxonomy: 207RP1001X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D2176842
LAB Type Rural Health Clinic
Facility Name JEFFERSON REGIONAL MONTICELLO MEDICAL CLINIC 2
Street 733 ROBERTS DRIVE
City MONTICELLO
State AR
ZIP 71655
Phone 870 460-4766
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/27/2023
Certificate Expiration Date 12/26/2025
Facility Type Rural Health Clinic
Lab Director MS. APRIL WYNNE

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