05D2302474 CLIA NUMBER - IRC-SUTTER HEALTH JACKSON, LLC

Laboratory Demographics

  • CLIA Code: 05D2302474
  • Facility Name: IRC-SUTTER HEALTH JACKSON, LLC
  • Facility Address: 12030 INDUSTRY BLVD
    JACKSON, CA
    ZIP 95642
  • Facility Phone: 209 273-3060
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: ADARSH BHAT
  • NPI Number: 1124893615
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2302474
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name IRC-SUTTER HEALTH JACKSON, LLC
Street 12030 INDUSTRY BLVD
City JACKSON
State CA
ZIP 95642
Phone 209 273-3060
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/10/2024
Certificate Expiration Date 4/9/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director ADARSH BHAT

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This page was last updated on: 9/29/2025