CLIA lab
CLIA 04D2104588: Northwest Medical Plaza-Bentonville
Bentonville, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D2104588 belongs to Northwest Medical Plaza-Bentonville in Bentonville, AR.
Certificate of Waiver, effective November 9, 2025, expires November 8, 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
- November 9, 2025
- Certificate expiration
- November 8, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- November 9, 2015
- 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
- 04D2104588
- Lab name
- Northwest Medical Plaza-Bentonville
- Address
- 601 SW Regional Airport Blvd, Bentonville, AR 72713
- Phone
- (479) 553-2664
- Fax
- (479) 553-2536
Annual test volume the lab reported
- Waived tests
- 3,500
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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Related
Questions
What is the CLIA number for Northwest Medical Plaza-Bentonville in Bentonville?
04D2104588, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Northwest Medical Plaza-Bentonville hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 04D2104588 expire?
The CMS file lists November 8, 2027 as the certificate expiration date; the certificate took effect November 9, 2025.