04D2306540 CLIA NUMBER - MAINLINE PCSSD SBHC- LITTLE ROCK MILLS

Laboratory Demographics

  • CLIA Code: 04D2306540
  • Facility Name: MAINLINE PCSSD SBHC- LITTLE ROCK MILLS
  • Facility Address: 1205 E DIXON ROAD
    LITTLE ROCK, AR
    ZIP 72206
  • Facility Phone: 870 737-3015
  • Facility Type: School/Student Health Service
  • Facility Type: Waiver
  • Lab Director: DR. KERRY PENNINGTON
  • NPI Number: 1164264834
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2306540
LAB Type School/Student Health Service
Facility Name MAINLINE PCSSD SBHC- LITTLE ROCK MILLS
Street 1205 E DIXON ROAD
City LITTLE ROCK
State AR
ZIP 72206
Phone 870 737-3015
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/20/2024
Certificate Expiration Date 6/19/2026
Facility Type School/Student Health Service
Lab Director DR. KERRY PENNINGTON

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