10D0904325 CLIA NUMBER - ST AUGUSTINE DIALYSIS

Laboratory Demographics

  • CLIA Code: 10D0904325
  • Facility Name: ST AUGUSTINE DIALYSIS
  • Facility Address: 264 SOUTH PARK CIRCLE EAST
    SAINT AUGUSTINE, FL
    ZIP 32086
  • Facility Phone: 904 808-0445
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: AMIR A. MALIK
  • NPI Number: 1013997600
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D0904325
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name ST AUGUSTINE DIALYSIS
Street 264 SOUTH PARK CIRCLE EAST
City SAINT AUGUSTINE
State FL
ZIP 32086
Phone 904 808-0445
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/16/2025
Certificate Expiration Date 8/15/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director AMIR A. MALIK

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This page was last updated on: 9/29/2025