03D0993719 CLIA NUMBER - FMC DIALYSIS SERVICES OF GRANITE

Laboratory Demographics

CLIA Number: 03D0993719

Facility Name: FMC DIALYSIS SERVICES OF GRANITE

Facility Address:
14510 W SHUMWAY DR STE 100
SUN CITY WEST, AZ
ZIP 85375
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Facility Phone Number: 623 546-2718

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1235241035

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D0993719
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FMC DIALYSIS SERVICES OF GRANITE
Street	14510 W SHUMWAY DR STE 100
City	SUN CITY WEST
State	AZ
ZIP	85375
Phone	623 546-2718
CertificateType	4
CertificateEffectiveDate	11/21/2023
CertificateExpirationDate	11/20/2025
FacilityType	Waiver

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