CLIA lab
CLIA 04D2113561: Wagner Medical Clinic
Blytheville, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D2113561 belongs to Wagner Medical Clinic in Blytheville, AR.
Certificate of Waiver, effective May 25, 2026, expires May 24, 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
- May 25, 2026
- Certificate expiration
- May 24, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- May 25, 2016
- Facility type
- Physician office
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
- Directly affiliated labs
- 3
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 04D2113561
- Lab name
- Wagner Medical Clinic
- Address
- 1001 N 6th Street, Blytheville, AR 72315
- Phone
- (870) 561-3300
- Fax
- (870) 561-3307
Annual test volume the lab reported
- Waived tests
- 500
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Affiliated CLIA numbers
Other labs in Blytheville, AR
- Access Medical Clinic Arkansas LLCCertificate of Waiver, Physician office04D2289685
- Adult Medicine Clinic of BlythevilleCertificate of Waiver, Physician office04D1053557
- Air-Evac 113Certificate of Waiver, Ambulance04D2064713
- Allied Health Connect Associates LLCCertificate of Waiver, Public health laboratory04D2288387
- B M A BlythevilleCertificate of Waiver, End stage renal disease dialysis facility04D0942154
- Constance H Smith MD PACertificate of Waiver, Physician office04D2049073
- 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 Wagner Medical Clinic in Blytheville?
04D2113561, 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 04D2113561 expire?
The CMS file lists May 24, 2028 as the certificate expiration date; the certificate took effect May 25, 2026.