CLIA lab
CLIA 04D1064229: Great River Pediatric Clinic
Blytheville, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D1064229 belongs to Great River Pediatric Clinic in Blytheville, AR.
Certificate of Waiver, effective February 1, 2025, expires January 31, 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 of Waiver
- Certificate effective
- February 1, 2025
- Certificate expiration
- January 31, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- February 1, 2007
- 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
- 04D1064229
- Lab name
- Great River Pediatric Clinic
- Address
- 1521 North 10th Street Suite F, Blytheville, AR 72315
- Phone
- (870) 780-6832
- Fax
- (870) 780-6919
Annual test volume the lab reported
- Waived tests
- 1,650
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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- B M A BlythevilleCertificate of Waiver, End stage renal disease dialysis facility04D0942154
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- Delta Behavioral Health LLCCertificate of Waiver, Other04D2275300
- Doc Network - Nucor Yamato Stell Clinic, theCertificate of Waiver, Physician office04D2223423
- Everside Health Blytheville Ar ClinicCertificate of Waiver, Other04D2258358
- Family Medicine Assoc of BlythevilleCertificate of Compliance, Physician office04D0467710
Related
Questions
What is the CLIA number for Great River Pediatric Clinic in Blytheville?
04D1064229, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Great River Pediatric Clinic hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 04D1064229 expire?
The CMS file lists January 31, 2027 as the certificate expiration date; the certificate took effect February 1, 2025.