01D2054751 CLIA NUMBER - BREWTON DIALYSIS

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Laboratory Demographics

CLIA Number: 01D2054751

Facility Name: BREWTON DIALYSIS

Facility Address:
1023 DOUGLAS AVE STE 300
BREWTON, AL
ZIP 36426
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Facility Phone Number: 251 867-8509

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1336483478

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	01D2054751
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	BREWTON DIALYSIS
Street	1023 DOUGLAS AVE STE 300
City	BREWTON
State	AL
ZIP	36426
Phone	251 867-8509
CertificateType	4
CertificateEffectiveDate	2/27/2023
CertificateExpirationDate	2/26/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024