CLIA lab
CLIA 04D1011789: Millard Henry Clinic-Ob/Surg
Russellville, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D1011789 belongs to Millard Henry Clinic-Ob/Surg in Russellville, AR.
Certificate of Compliance, effective August 15, 2025, expires August 14, 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
Run it in Rivvi
Map your lab's test names to LOINC codes
Open in RivviFree to start. Opens Rivvi, the AI workspace for healthcare teams.
Certificate
- Certificate type
- Certificate of Compliance
- Certificate effective
- August 15, 2025
- Certificate expiration
- August 14, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- April 23, 2003
- 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
- 04D1011789
- Lab name
- Millard Henry Clinic-Ob/Surg
- Additional name
- ST Mary's Physician Services LLC
- Address
- 105 Skyline Drive, Russellville, AR 72801
- Phone
- (479) 890-7146
- Fax
- (479) 890-7145
Annual test volume the lab reported
- Waived tests
- 1,368
- Provider-performed microscopy tests
- 2,184
- Other nonwaived tests
- 9,815
- Total
- 13,367
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Russellville, AR
- Ar Heart Hospital Rural Health Svcs - RussellvilleCertificate of Waiver, Physician office04D1096786
- Arcare 92Certificate of Waiver, Federally qualified health center04D2308343
- Arcare 98Certificate of Waiver, Federally qualified health center04D2329669
- Arkansas DermatologyCertificate of Compliance, Physician office04D2178013
- Arkansas Dermatology CenterCertificate for Provider-Performed Microscopy Procedures, Physician office04D0949890
- Arkansas Occupational Health Clinic - RussellvilleCertificate of Waiver, Physician office04D2119425
- Arkansas Renal Group, PA - RussellvilleCertificate of Waiver, Physician office04D2112078
- Arkansas Tech University Health & Wellness CenterCertificate for Provider-Performed Microscopy Procedures, School or student health service04D0909870
- Arkansas Urology/RussellvilleCertificate for Provider-Performed Microscopy Procedures, Physician office04D1100397
- BPC Plasma, IncCertificate of Accreditation, Independent04D2162256
Related
Questions
What is the CLIA number for Millard Henry Clinic-Ob/Surg in Russellville?
04D1011789, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Millard Henry Clinic-Ob/Surg hold?
A Certificate of Compliance, according to the CMS file.
When does CLIA 04D1011789 expire?
The CMS file lists August 14, 2027 as the certificate expiration date; the certificate took effect August 15, 2025.