10D0950105 CLIA NUMBER - FORT MYERS SOUTH DIALYSIS

Laboratory Demographics

CLIA Number: 10D0950105

Facility Name: FORT MYERS SOUTH DIALYSIS

Facility Address:
8850 GLADIOLUS DR
FORT MYERS, FL
ZIP 33908
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Facility Phone Number: 941 482-0080

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1114994688

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0950105
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FORT MYERS SOUTH DIALYSIS
Street	8850 GLADIOLUS DR
City	FORT MYERS
State	FL
ZIP	33908
Phone	941 482-0080
CertificateType	4
CertificateEffectiveDate	8/18/2022
CertificateExpirationDate	8/17/2024
FacilityType	Waiver

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