04D2284769 CLIA NUMBER - RIVER VALLEY SURGERY CENTER

Laboratory Demographics

  • CLIA Code: 04D2284769
  • Facility Name: RIVER VALLEY SURGERY CENTER
  • Facility Address: 3110 WEST MAIN STREET
    RUSSELLVILLE, AR
    ZIP 72801
  • Facility Phone: 479 967-7770
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: AHMAD RAFI
  • NPI Number: 1053037218
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2284769
LAB Type Ambulatory Surgery Center
Facility Name RIVER VALLEY SURGERY CENTER
Street 3110 WEST MAIN STREET
City RUSSELLVILLE
State AR
ZIP 72801
Phone 479 967-7770
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/28/2025
Certificate Expiration Date 6/27/2027
Facility Type Ambulatory Surgery Center
Lab Director AHMAD RAFI

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