CLIA lab
CLIA 04D2126174: Lake Village School Based Clinic
Lake Village, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D2126174 belongs to Lake Village School Based Clinic in Lake Village, AR.
Certificate of Waiver, effective February 21, 2025, expires February 20, 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 21, 2025
- Certificate expiration
- February 20, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- February 21, 2017
- Facility type
- School or student health service
- Ownership (control type)
- Other
- 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
- 04D2126174
- Lab name
- Lake Village School Based Clinic
- Additional name
- Mainline Health Systems, Inc
- Address
- 360A W Hwy 82, Lake Village, AR 71653
- Phone
- (870) 538-5414
- Fax
- (870) 538-5412
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.
Other labs in Lake Village, AR
- Chicot Memorial Medical CenterCertificate of Compliance, Hospital04D0465387
- Chicot Memorial Medical Center Home HealthCertificate of Waiver, Home health agency04D0681352
- Hunter's Pharmacy, IncCertificate of Waiver, Pharmacy04D1095104
- Lake Village ClinicCertificate of Waiver, Physician office04D0693694
- Lake Village Rehab-Care CTRCertificate of Waiver, Skilled nursing or nursing facility04D2009218
- Lakeside High School Based ClinicCertificate of Waiver, School or student health service04D2142136
- Pathway Recovery DevelopmentCertificate of Waiver, Comprehensive outpatient rehab facility04D2312252
- Southeast Rehabilitation HospitalCertificate of Waiver, Hospital04D1059020
- Southeast Rural Health ClinicCertificate of Waiver, Rural health clinic04D2183693
Related
Questions
What is the CLIA number for Lake Village School Based Clinic in Lake Village?
04D2126174, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Lake Village School Based Clinic hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 04D2126174 expire?
The CMS file lists February 20, 2027 as the certificate expiration date; the certificate took effect February 21, 2025.