CLIA lab
CLIA 04D2220559: Ancient Birth Tradition
Fayetteville, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D2220559 belongs to Ancient Birth Tradition in Fayetteville, AR.
Certificate of Waiver, effective April 13, 2025, expires April 12, 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
- April 13, 2025
- Certificate expiration
- April 12, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- April 13, 2021
- Facility type
- Other practitioner
- 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
- 04D2220559
- Lab name
- Ancient Birth Tradition
- Address
- 28 S College Ave #4, Fayetteville, AR 72701
- Phone
- (479) 236-7049
Annual test volume the lab reported
- Waived tests
- 300
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 Ancient Birth Tradition in Fayetteville?
04D2220559, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Ancient Birth Tradition hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 04D2220559 expire?
The CMS file lists April 12, 2027 as the certificate expiration date; the certificate took effect April 13, 2025.