CLIA lab
CLIA 04D2258239: Mid-Cities Ambulatory Surgery Center, LLC
Bentonville, AR. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 04D2258239 belongs to Mid-Cities Ambulatory Surgery Center, LLC in Bentonville, AR.
Certificate of Waiver, effective April 19, 2026, expires April 18, 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
- April 19, 2026
- Certificate expiration
- April 18, 2028
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- April 19, 2022
- Facility type
- Ambulatory surgery center
- 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
- 04D2258239
- Lab name
- Mid-Cities Ambulatory Surgery Center, LLC
- Address
- 2902 SE Mid-Cities Drive, Bentonville, AR 72712
- Phone
- (501) 766-1065
- Fax
- (501) 239-2046
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 Mid-Cities Ambulatory Surgery Center, LLC in Bentonville?
04D2258239, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Mid-Cities Ambulatory Surgery Center, LLC hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 04D2258239 expire?
The CMS file lists April 18, 2028 as the certificate expiration date; the certificate took effect April 19, 2026.