04D2220551 CLIA NUMBER - SPRING RIVER CLINIC, LLC

Laboratory Demographics

  • CLIA Code: 04D2220551
  • Facility Name: SPRING RIVER CLINIC, LLC
  • Facility Address: 201 N WALNUT
    IMBODEN, AR
    ZIP 72434
  • Facility Phone: 423 534-4917
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. JEFFREY L. COON
  • NPI Number: 1598356982
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2220551
LAB Type Physician Office
Facility Name SPRING RIVER CLINIC, LLC
Street 201 N WALNUT
City IMBODEN
State AR
ZIP 72434
Phone 423 534-4917
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/13/2025
Certificate Expiration Date 4/12/2027
Facility Type Physician Office
Lab Director DR. JEFFREY L. COON

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