04D2194560 CLIA NUMBER - PRIMARY CARE 360 - SHERWOOD

Laboratory Demographics

  • CLIA Code: 04D2194560
  • Facility Name: PRIMARY CARE 360 - SHERWOOD
  • Facility Address: 100 SHADOW OAK DRIVE
    SHERWOOD, AR
    ZIP 72120
  • Facility Phone: 501 833-4001
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. KHALID RAYAZ
  • NPI Number: 1124678586
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D2194560
LAB Type Physician Office
Facility Name PRIMARY CARE 360 - SHERWOOD
Street 100 SHADOW OAK DRIVE
City SHERWOOD
State AR
ZIP 72120
Phone 501 833-4001
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2024
Certificate Expiration Date 9/30/2026
Facility Type Physician Office
Lab Director DR. KHALID RAYAZ

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