04D2296587 CLIA NUMBER - VITALITY PLUS LLC

Laboratory Demographics

  • CLIA Code: 04D2296587
  • Facility Name: VITALITY PLUS LLC
  • Facility Address: 19 MEDICAL PLAZA SUITE 50
    MOUNTAIN HOME, AR
    ZIP 72653
  • Facility Phone: 870 580-0283
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. WILLIAM C. SMITH
  • NPI Number: 1023639614
  • Taxonomy: 261Q00000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2296587
LAB Type Physician Office
Facility Name VITALITY PLUS LLC
Street 19 MEDICAL PLAZA SUITE 50
City MOUNTAIN HOME
State AR
ZIP 72653
Phone 870 580-0283
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/2/2024
Certificate Expiration Date 1/1/2026
Facility Type Physician Office
Lab Director DR. WILLIAM C. SMITH

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