04D2315853 CLIA NUMBER - BENTONVILLE ENDOSCOPY CENTER LLC

Laboratory Demographics

  • CLIA Code: 04D2315853
  • Facility Name: BENTONVILLE ENDOSCOPY CENTER LLC
  • Facility Address: 3700 SE DODSON ROAD SUITE 4
    BENTONVILLE, AR
    ZIP 72712
  • Facility Phone: 817 893-2381
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: KEVIN OKEEFE
  • NPI Number: 1013731397
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 04D2315853
LAB Type Ambulatory Surgery Center
Facility Name BENTONVILLE ENDOSCOPY CENTER LLC
Street 3700 SE DODSON ROAD SUITE 4
City BENTONVILLE
State AR
ZIP 72712
Phone 817 893-2381
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/20/2024
Certificate Expiration Date 12/19/2026
Facility Type Ambulatory Surgery Center
Lab Director KEVIN OKEEFE

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