CLIA lab
CLIA 04D1055975: Wagner Medical Clinic
Lepanto, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D1055975 belongs to Wagner Medical Clinic in Lepanto, AR.
Certificate of Waiver, effective June 30, 2026, expires June 29, 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
- June 30, 2026
- Certificate expiration
- June 29, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- June 30, 2006
- Facility type
- Physician office
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
- Directly affiliated labs
- 1
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 04D1055975
- Lab name
- Wagner Medical Clinic
- Address
- 730 Greenwood Ave, Lepanto, AR 72354
- Phone
- (870) 561-3300
Annual test volume the lab reported
- Waived tests
- 524
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Affiliated CLIA numbers
Other labs in Lepanto, AR
Related
Questions
What is the CLIA number for Wagner Medical Clinic in Lepanto?
04D1055975, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Wagner Medical Clinic hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 04D1055975 expire?
The CMS file lists June 29, 2028 as the certificate expiration date; the certificate took effect June 30, 2026.