10D0883374 CLIA NUMBER - MARIANNA DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 10D0883374

Facility Name: MARIANNA DIALYSIS CENTER

Facility Address:
2930 OPTIMIST DRIVE
MARIANNA, FL
ZIP 32448
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Facility Phone Number: 850 482-2152

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1083944573

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	10D0883374
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MARIANNA DIALYSIS CENTER
Street	2930 OPTIMIST DRIVE
City	MARIANNA
State	FL
ZIP	32448
Phone	850 482-2152
CertificateType	4
CertificateEffectiveDate	10/16/2022
CertificateExpirationDate	10/15/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024