10D0954678 CLIA NUMBER - BONITA SPRINGS DIALYSIS

Laboratory Demographics

CLIA Number: 10D0954678

Facility Name: BONITA SPRINGS DIALYSIS

Facility Address:
9134 BONITA BEACH RD
BONITA SPRINGS, FL
ZIP 34135
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Facility Phone Number: 615 341-5897

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1306813993

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0954678
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	BONITA SPRINGS DIALYSIS
Street	9134 BONITA BEACH RD
City	BONITA SPRINGS
State	FL
ZIP	34135
Phone	615 341-5897
CertificateType	4
CertificateEffectiveDate	12/4/2022
CertificateExpirationDate	12/3/2024
FacilityType	Waiver

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