10D0715088 CLIA NUMBER - RAI US 19 NORTH PALM HARBOR

Laboratory Demographics

CLIA Number: 10D0715088

Facility Name: RAI US 19 NORTH PALM HARBOR

Facility Address:
29296 US HWY 19 N STE 1
CLEARWATER, FL
ZIP 33761
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Facility Phone Number: 727 785-9036

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1932118932

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0715088
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	RAI US 19 NORTH PALM HARBOR
Street	29296 US HWY 19 N STE 1
City	CLEARWATER
State	FL
ZIP	33761
Phone	727 785-9036
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