10D0864369 CLIA NUMBER - NORTHEAST FLORIDA DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 10D0864369

Facility Name: NORTHEAST FLORIDA DIALYSIS CENTER

Facility Address:
2141 LOCH RANE BLVD STE 112 & 115
ORANGE PARK, FL
ZIP 32073
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Facility Phone Number: 904 272-7331

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1033135306

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0864369
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	NORTHEAST FLORIDA DIALYSIS CENTER
Street	2141 LOCH RANE BLVD STE 112 & 115
City	ORANGE PARK
State	FL
ZIP	32073
Phone	904 272-7331
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