CLIA lab
CLIA 04D0976193: Russell Dermatology of Conway PLLC
Conway, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D0976193 belongs to Russell Dermatology of Conway PLLC in Conway, AR.
Certificate for Provider-Performed Microscopy Procedures, effective August 11, 2025, expires August 10, 2027.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate for Provider-Performed Microscopy Procedures
- Certificate effective
- August 11, 2025
- Certificate expiration
- August 10, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- July 27, 2000
- Facility type
- Physician office
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 04D0976193
- Lab name
- Russell Dermatology of Conway PLLC
- Address
- 2425 Dave Ward Drive Suite 202, Conway, AR 72034
- Phone
- (501) 328-5050
- Fax
- (501) 328-2131
Annual test volume the lab reported
- Provider-performed microscopy tests
- 140
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Conway, AR
- Ael - ConwayCertificate of Compliance, Independent04D2115207
- Amity Road PharmacyCertificate of Waiver, Pharmacy04D2154320
- Amy R Hudson, MDCertificate of Compliance, Other04D2063453
- Arcare 24Certificate of Waiver, Federally qualified health center04D2034996
- Aristotle Diagnostic Laboratories LLCCertificate of Accreditation, Independent04D2253867
- Arkansas DermatologyCertificate of Compliance, Physician office04D2028520
- Arkansas Heart Hospital Clinic - ConwayCertificate of Waiver, Physician office04D2090186
- Arkansas Pediatrics of ConwayCertificate of Compliance, Physician office04D0913091
- Arkansas Urology - ConwayCertificate for Provider-Performed Microscopy Procedures, Physician office04D2140908
- Aveon Renal Care, LLCCertificate of Waiver, End stage renal disease dialysis facility04D2338583
Related
Questions
What is the CLIA number for Russell Dermatology of Conway PLLC in Conway?
04D0976193, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Russell Dermatology of Conway PLLC hold?
A Certificate for Provider-Performed Microscopy Procedures, according to the CMS file.
When does CLIA 04D0976193 expire?
The CMS file lists August 10, 2027 as the certificate expiration date; the certificate took effect August 11, 2025.