04D2267158 CLIA NUMBER - HEALTHWISE WELLNESS DIRECT PLLC

Laboratory Demographics

  • CLIA Code: 04D2267158
  • Facility Name: HEALTHWISE WELLNESS DIRECT PLLC
  • Facility Address: 4014 OLD WARREN RD
    PINE BLUFF, AR
    ZIP 71603
  • Facility Phone: 870 454-4354
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: TOCHI AMAGWULA
  • NPI Number: 1336859354
  • Taxonomy: 207V00000X - Obstetrics & Gynecology

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CLIA Record

Field Name Field Value
CLIA Number 04D2267158
LAB Type Physician Office
Facility Name HEALTHWISE WELLNESS DIRECT PLLC
Street 4014 OLD WARREN RD
City PINE BLUFF
State AR
ZIP 71603
Phone 870 454-4354
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/22/2024
Certificate Expiration Date 8/21/2026
Facility Type Physician Office
Lab Director TOCHI AMAGWULA

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