CLIA lab
CLIA 04D1066504: ST John's Place of Arkansas LLC
Fordyce, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D1066504 belongs to ST John's Place of Arkansas LLC in Fordyce, AR.
Certificate of Waiver, effective March 26, 2025, expires March 25, 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
- March 26, 2025
- Certificate expiration
- March 25, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- March 26, 2007
- Facility type
- Skilled nursing or nursing facility
- 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
- 04D1066504
- Lab name
- ST John's Place of Arkansas LLC
- Address
- 1400 Hwy 79-167 By-Pass, Fordyce, AR 71742
- Phone
- (870) 352-2104
- Fax
- (870) 352-8969
Annual test volume the lab reported
- Waived tests
- 5,266
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Fordyce, AR
- Dallas County Medical CenterCertificate of Compliance, Hospital04D0689262
- Dcmc Family ClinicCertificate of Waiver, Rural health clinic04D1066528
- Elite Home HealthCertificate of Waiver, Home health agency04D0698540
- Millcreek of ArkansasCertificate of Waiver, Intermediate care facility for individuals with intellectual disabilities04D1027329
- Millcreek of Arkansas ICF MRCertificate of Waiver, Intermediate care facility for individuals with intellectual disabilities04D2010339
- Nutt-Walley Clinic of Dallas CountyCertificate of Waiver, Rural health clinic04D1089243
- Walmart Pharmacy 10-0339Certificate of Waiver, Pharmacy04D2139457
Related
Questions
What is the CLIA number for ST John's Place of Arkansas LLC in Fordyce?
04D1066504, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does ST John's Place of Arkansas LLC hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 04D1066504 expire?
The CMS file lists March 25, 2027 as the certificate expiration date; the certificate took effect March 26, 2025.