10D0984200 CLIA NUMBER - FORT PIERCE KIDNEY CARE

Laboratory Demographics

CLIA Number: 10D0984200

Facility Name: FORT PIERCE KIDNEY CARE

Facility Address:
2000 HARTMAN RD SUITE 2
FORT PIERCE, FL
ZIP 34947
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Facility Phone Number: 772 467-1117

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1821568627

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D0984200
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FORT PIERCE KIDNEY CARE
Street	2000 HARTMAN RD SUITE 2
City	FORT PIERCE
State	FL
ZIP	34947
Phone	772 467-1117
CertificateType	4
CertificateEffectiveDate	3/16/2023
CertificateExpirationDate	3/15/2025
FacilityType	Waiver

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