04D2255950 CLIA NUMBER - CARDIOLOGY ASSOCIATES OF N CENTRAL ARK ST MARY'S PHYSICIAN SERVICES LLC

Laboratory Demographics

  • CLIA Code: 04D2255950
  • Facility Name: CARDIOLOGY ASSOCIATES OF N CENTRAL ARK ST MARY'S PHYSICIAN SERVICES LLC
  • Facility Address: 2205 WEST MAIN
    RUSSELLVILLE, AR
    ZIP 72801
  • Facility Phone: 479 968-4311
  • Facility Type: Comp. Outpatient Rehab Facility
  • Facility Type: Waiver
  • Lab Director: JULIE SCOTT
  • NPI Number: 1720356207
  • Taxonomy: 207RI0011X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 04D2255950
LAB Type Comp. Outpatient Rehab Facility
Facility Name CARDIOLOGY ASSOCIATES OF N CENTRAL ARK ST MARY'S PHYSICIAN SERVICES LLC
Street 2205 WEST MAIN
City RUSSELLVILLE
State AR
ZIP 72801
Phone 479 968-4311
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/18/2024
Certificate Expiration Date 3/17/2026
Facility Type Comp. Outpatient Rehab Facility
Lab Director JULIE SCOTT

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