10D0273394 CLIA NUMBER - DELAND DIALYSIS

Laboratory Demographics

CLIA Number: 10D0273394

Facility Name: DELAND DIALYSIS

Facility Address:
350 E NEW YORK AVE
DELAND, FL
ZIP 32724
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Facility Phone Number: 904 738-2570

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1932176484

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0273394
LAB Type	Community Clinic
Facility Name	DELAND DIALYSIS
Street	350 E NEW YORK AVE
City	DELAND
State	FL
ZIP	32724
Phone	904 738-2570
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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