CLIA lab
CLIA 04D1022158: Executive Park Surgery Center of Fort Smith, Inc
Fort Smith, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D1022158 belongs to Executive Park Surgery Center of Fort Smith, Inc in Fort Smith, AR.
Certificate of Waiver, effective February 9, 2026, expires February 8, 2028.
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 of Waiver
- Certificate effective
- February 9, 2026
- Certificate expiration
- February 8, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- February 9, 2004
- Facility type
- Ambulatory surgery center
- 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
- 04D1022158
- Lab name
- Executive Park Surgery Center of Fort Smith, Inc
- Additional name
- DBA Executive Park Surgery Center
- Address
- 3314 South 70th Street, Fort Smith, AR 72903
- Phone
- (479) 424-2744
- Fax
- (479) 424-2745
Annual test volume the lab reported
- Waived tests
- 100
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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- Actss A Common Thread Supportive ServicesCertificate of Waiver, Community clinic04D2349408
- Advanced Cataract Surgery Laser CenterCertificate of Waiver, Ambulatory surgery center04D1041984
- Air Evac Lifeteam 149Certificate of Waiver, Mobile lab04D2143000
- Anderson Discount PharmacyCertificate of Waiver, Pharmacy04D2153217
- Arc Best Wellness CenterCertificate of Waiver, Physician office04D2074469
- Arcare - Fort SmithCertificate of Waiver, Federally qualified health center04D2049894
- Arcare 159Certificate of Waiver, Federally qualified health center04D2324553
- Area Agency on Aging of Western Ar, IncCertificate of Waiver, Home health agency04D0685272
Related
Questions
What is the CLIA number for Executive Park Surgery Center of Fort Smith, Inc in Fort Smith?
04D1022158, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Executive Park Surgery Center of Fort Smith, Inc hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 04D1022158 expire?
The CMS file lists February 8, 2028 as the certificate expiration date; the certificate took effect February 9, 2026.