10D0645107 CLIA NUMBER - FMC DIALYSIS NORTH JACKSONVILLE

Laboratory Demographics

CLIA Number: 10D0645107

Facility Name: FMC DIALYSIS NORTH JACKSONVILLE

Facility Address:
10614 LEM TURNER ROAD
JACKSONVILLE, FL
ZIP 32218
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Facility Phone Number: 904 768-8576

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1609988450

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0645107
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FMC DIALYSIS NORTH JACKSONVILLE
Street	10614 LEM TURNER ROAD
City	JACKSONVILLE
State	FL
ZIP	32218
Phone	904 768-8576
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