04D2292064 CLIA NUMBER - WASHINGTON REGIONAL PLAZA INTERNAL MEDICINE CLINIC

Laboratory Demographics

  • CLIA Code: 04D2292064
  • Facility Name: WASHINGTON REGIONAL PLAZA INTERNAL MEDICINE CLINIC
  • Facility Address: 3 E APPLEBY RD SUITE 302
    FAYETTEVILLE, AR
    ZIP 72703
  • Facility Phone: 479 404-1400
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. ANNE G. MONTGOMERY
  • NPI Number: 1366408973
  • Taxonomy: 2084P0805X - Psychiatry & Neurology

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CLIA Record

Field Name Field Value
CLIA Number 04D2292064
LAB Type Physician Office
Facility Name WASHINGTON REGIONAL PLAZA INTERNAL MEDICINE CLINIC
Street 3 E APPLEBY RD SUITE 302
City FAYETTEVILLE
State AR
ZIP 72703
Phone 479 404-1400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/19/2025
Certificate Expiration Date 10/18/2027
Facility Type Physician Office
Lab Director DR. ANNE G. MONTGOMERY

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