04D1038327 CLIA NUMBER - PINE BLUFF - U S RENAL CARE PINE BLUFF DIALYSIS, INC

Laboratory Demographics

CLIA Number: 04D1038327

Facility Name: PINE BLUFF - U S RENAL CARE PINE BLUFF DIALYSIS, INC

Facility Address:
2800 WEST 28TH STREET
PINE BLUFF, AR
ZIP 71603
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Facility Phone Number: 870 534-7400

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1073590923

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D1038327
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	PINE BLUFF - U S RENAL CARE PINE BLUFF DIALYSIS, INC
Street	2800 WEST 28TH STREET
City	PINE BLUFF
State	AR
ZIP	71603
Phone	870 534-7400
CertificateType	4
CertificateEffectiveDate	3/16/2023
CertificateExpirationDate	3/15/2025
FacilityType	Waiver

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