04D2304384 CLIA NUMBER - CLEAR CREEK WELLNESS LLC

Laboratory Demographics

  • CLIA Code: 04D2304384
  • Facility Name: CLEAR CREEK WELLNESS LLC
  • Facility Address: 5203 WILLOW CREEK DRIVE SUITE B
    SPRINGDALE, AR
    ZIP 72762
  • Facility Phone: 479 301-8970
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: HERON B. MARTIN
  • NPI Number: 1215794599
  • Taxonomy: 363LF0000X - Nurse Practitioner

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 04D2304384
LAB Type Physician Office
Facility Name CLEAR CREEK WELLNESS LLC
Street 5203 WILLOW CREEK DRIVE SUITE B
City SPRINGDALE
State AR
ZIP 72762
Phone 479 301-8970
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/13/2024
Certificate Expiration Date 5/12/2026
Facility Type Physician Office
Lab Director HERON B. MARTIN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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