04D2249895 CLIA NUMBER - CALDWELL CLINICAL SERVICES

Laboratory Demographics

  • CLIA Code: 04D2249895
  • Facility Name: CALDWELL CLINICAL SERVICES
  • Facility Address: 8014 SOUTH FALLS BLVD
    WYNNE, AR
    ZIP 72396
  • Facility Phone: 870 238-7085
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: LISA G. FANCHER
  • NPI Number: 1902572977
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D2249895
LAB Type Community Clinic
Facility Name CALDWELL CLINICAL SERVICES
Street 8014 SOUTH FALLS BLVD
City WYNNE
State AR
ZIP 72396
Phone 870 238-7085
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/24/2024
Certificate Expiration Date 1/23/2026
Facility Type Community Clinic
Lab Director LISA G. FANCHER

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