MID-SOUTH RENAL CLINIC, PLC NPI 1093724346

Specialist in Marion, AR

NPI 1093724346 Organization Specialist CLIA Number 04D0978617 CLIA Certificate of Waiver

About MID-SOUTH RENAL CLINIC, PLC

Mid-south Renal Clinic, Plc is a provider established in Marion, Arkansas specializing in specialist. The NPI number of Mid-south Renal Clinic, Plc is 1093724346 and was assigned on August 2006. The practitioner's primary taxonomy code is 174400000X. The provider is registered as an organization and their NPI record was last updated 9 years ago. Mid-south Renal Clinic, Plc operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Mashhud M. Mirza M.d. (President)

The CLIA number of Mid-south Renal Clinic, Plc is 04D0978617 registered as a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Mid-south Renal Clinic, Plc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1093724346

Provider NameMID-SOUTH RENAL CLINIC, PLC
Provider Location Address1120 STATE HIGHWAY 77 STE 1 MARION, AR 72364
Provider Mailing AddressPO BOX 55 MARION, AR 72364
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date08-05-2006
Last Update Date05-03-2013


Primary Taxonomy

Taxonomy Code174400000X
ClassificationSpecialist
TypeOther Service Providers
Taxonomy DescriptionAn individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Business Address

MID-SOUTH RENAL CLINIC, PLC
1120 STATE HIGHWAY 77 STE 1
MARION, AR
ZIP 72364
Phone: (870) 733-1177
Fax: (870) 702-6128

Get Directions


Mailing Address

MID-SOUTH RENAL CLINIC, PLC
PO BOX 55
MARION, AR
ZIP 72364
Phone: (870) 733-1177
Fax: (870) 702-6128



Authorized Official

Authorized Official Name MASHHUD M. MIRZA M.D.
Authorized Official TitlePRESIDENT
Authorized Official Phone(870) 733-1177

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1093724346 is:

CLIA Number04D0978617
Facility TypePHYSICIAN OFFICE
Certificate TypeCertificate of Waiver

Group Taxonomy


193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
110217316OTHER (01)
159373002MEDICAID (05)AR
5F061MEDICARE PIN (08)AR
3154566OTHER (01)TN
5K483OTHER (01)AR
3723240MEDICARE PIN (08)TN

Other Providers at the same location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1972825545MRS. KIMBERLY LEIGH GERMAN FNP
Individual
Nurse Practitioner (Family)1120 STATE HIGHWAY 77 STE 1
MARION, AR 72364
(870) 733-1177

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.