03D1095201 CLIA NUMBER - FRESENIUS MEDICAL CARE KINGMAN

Laboratory Demographics

CLIA Number: 03D1095201

Facility Name: FRESENIUS MEDICAL CARE KINGMAN

Facility Address:
1721 AIRWAY AVE
KINGMAN, AZ
ZIP 86409
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Facility Phone Number: 928 681-2342

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1487818076

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	03D1095201
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FRESENIUS MEDICAL CARE KINGMAN
Street	1721 AIRWAY AVE
City	KINGMAN
State	AZ
ZIP	86409
Phone	928 681-2342
CertificateType	4
CertificateEffectiveDate	2/4/2023
CertificateExpirationDate	2/3/2025
FacilityType	Waiver

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