10D1067296 CLIA NUMBER - WEST PENSACOLA DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 10D1067296

Facility Name: WEST PENSACOLA DIALYSIS CENTER

Facility Address:
598 N FAIRFIELD DR STE 100
PENSACOLA, FL
ZIP 32506
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Facility Phone Number: 850 453-6066

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1326366329

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1067296
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WEST PENSACOLA DIALYSIS CENTER
Street	598 N FAIRFIELD DR STE 100
City	PENSACOLA
State	FL
ZIP	32506
Phone	850 453-6066
CertificateType	4
CertificateEffectiveDate	4/16/2023
CertificateExpirationDate	4/15/2025
FacilityType	Waiver

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