03D0534007 CLIA NUMBER - ISD RENAL, INC DBA PRESCOTT DIALYSIS

Laboratory Demographics

  • CLIA Code: 03D0534007
  • Facility Name: ISD RENAL, INC DBA PRESCOTT DIALYSIS
  • Facility Address: 980 WILLOW CREEK RD STE 101
    PRESCOTT, AZ
    ZIP 86301
  • Facility Phone: 928 776-9459
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: ROMANITA D. NICA
  • NPI Number: 1205881232
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 03D0534007
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name ISD RENAL, INC DBA PRESCOTT DIALYSIS
Street 980 WILLOW CREEK RD STE 101
City PRESCOTT
State AZ
ZIP 86301
Phone 928 776-9459
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/15/2024
Certificate Expiration Date 4/14/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director ROMANITA D. NICA

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This page was last updated on: 9/29/2025