10D0955593 CLIA NUMBER - ORLANDO SOUTHWEST DIALYSIS

Laboratory Demographics

CLIA Number: 10D0955593

Facility Name: ORLANDO SOUTHWEST DIALYSIS

Facility Address:
6925 LAKE ELLENOR DR STE 650
ORLANDO, FL
ZIP 32809
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Facility Phone Number: 407 852-1751

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1457329757

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0955593
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ORLANDO SOUTHWEST DIALYSIS
Street	6925 LAKE ELLENOR DR STE 650
City	ORLANDO
State	FL
ZIP	32809
Phone	407 852-1751
CertificateType	4
CertificateEffectiveDate	1/5/2023
CertificateExpirationDate	1/4/2025
FacilityType	Waiver

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