10D0714035 CLIA NUMBER - FORT MYERS DIALYSIS

Laboratory Demographics

CLIA Number: 10D0714035

Facility Name: FORT MYERS DIALYSIS

Facility Address:
4220 EXECUTIVE CIR STE 38
FORT MYERS, FL
ZIP 33916
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Facility Phone Number: 239 274-0845

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1255308722

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0714035
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FORT MYERS DIALYSIS
Street	4220 EXECUTIVE CIR STE 38
City	FORT MYERS
State	FL
ZIP	33916
Phone	239 274-0845
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