04D2184334 CLIA NUMBER - MEDEXPRESS SPRINGDALE PRIMARY CARE

Laboratory Demographics

CLIA Number: 04D2184334

Facility Name: MEDEXPRESS SPRINGDALE PRIMARY CARE

Facility Address:
1160 SOUTH 40TH ST, ROOMS 6 & 7
SPRINGDALE, AR
ZIP 72762
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Facility Phone Number: 479 750-2971

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1104247881

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D2184334
LAB Type	Physician Office
Facility Name	MEDEXPRESS SPRINGDALE PRIMARY CARE
Street	1160 SOUTH 40TH ST, ROOMS 6 & 7
City	SPRINGDALE
State	AR
ZIP	72762
Phone	479 750-2971
CertificateType	4
CertificateEffectiveDate	5/19/2022
CertificateExpirationDate	5/18/2024
FacilityType	Waiver

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