06D1094312 CLIA NUMBER - LIBERTY DIALYSIS CO/S SOUTH

Laboratory Demographics

CLIA Number: 06D1094312

Facility Name: LIBERTY DIALYSIS CO/S SOUTH

Facility Address:
2508 AIRPORT RD
COLORADO SPRINGS, CO
ZIP 80910
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Facility Phone Number: 719 227-7455

Facility Type: Blood Bank

Certificate Type: Waiver

NPI Number: 1063688844

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	06D1094312
LAB Type	Blood Bank
Facility Name	LIBERTY DIALYSIS CO/S SOUTH
Street	2508 AIRPORT RD
City	COLORADO SPRINGS
State	CO
ZIP	80910
Phone	719 227-7455
CertificateType	4
CertificateEffectiveDate	1/15/2023
CertificateExpirationDate	1/14/2025
FacilityType	Waiver

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