10D1090544 CLIA NUMBER - JACKSONVILLE SOUTH DIALYSIS CENTER UNIT 114

Laboratory Demographics

  • CLIA Code: 10D1090544
  • Facility Name: JACKSONVILLE SOUTH DIALYSIS CENTER UNIT 114
  • Facility Address: 14965 OLD ST AUGUSTINE RD
    JACKSONVILLE, FL
    ZIP 32258
  • Facility Phone: 904 880-9494
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: KOTESWARI KANCHA
  • NPI Number: 1255587531
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D1090544
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name JACKSONVILLE SOUTH DIALYSIS CENTER UNIT 114
Street 14965 OLD ST AUGUSTINE RD
City JACKSONVILLE
State FL
ZIP 32258
Phone 904 880-9494
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/14/2024
Certificate Expiration Date 10/13/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director KOTESWARI KANCHA

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This page was last updated on: 9/29/2025