04D1075322 CLIA NUMBER - MENA DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 04D1075322

Facility Name: MENA DIALYSIS CENTER

Facility Address:
1200 CRESTWOOD CIRCLE
MENA, AR
ZIP 71953
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Facility Phone Number: 479 394-8085

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1477744670

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	04D1075322
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MENA DIALYSIS CENTER
Street	1200 CRESTWOOD CIRCLE
City	MENA
State	AR
ZIP	71953
Phone	479 394-8085
CertificateType	4
CertificateEffectiveDate	10/17/2023
CertificateExpirationDate	10/16/2025
FacilityType	Waiver

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