04D0909872 CLIA NUMBER - STUTTGART DIALYSIS

Laboratory Demographics

CLIA Number: 04D0909872

Facility Name: STUTTGART DIALYSIS

Facility Address:
805 MADISON STREET
STUTTGART, AR
ZIP 72160
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Facility Phone Number: 870 673-8823

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1376655274

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D0909872
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	STUTTGART DIALYSIS
Street	805 MADISON STREET
City	STUTTGART
State	AR
ZIP	72160
Phone	870 673-8823
CertificateType	4
CertificateEffectiveDate	12/19/2023
CertificateExpirationDate	12/18/2025
FacilityType	Waiver

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