10D0645562 CLIA NUMBER - CENTRAL TAMPA DIALYSIS

Laboratory Demographics

CLIA Number: 10D0645562

Facility Name: CENTRAL TAMPA DIALYSIS

Facility Address:
4204 N MACDILL AVE, SOUTH BUILDING
TAMPA, FL
ZIP 33607
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Facility Phone Number: 813 871-3202

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1053389536

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0645562
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	CENTRAL TAMPA DIALYSIS
Street	4204 N MACDILL AVE, SOUTH BUILDING
City	TAMPA
State	FL
ZIP	33607
Phone	813 871-3202
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