10D1096614 CLIA NUMBER - ORLANDO PARK DIALYSIS

Laboratory Demographics

CLIA Number: 10D1096614

Facility Name: ORLANDO PARK DIALYSIS

Facility Address:
5397 W COLONIAL DR STE 120
ORLANDO, FL
ZIP 32808
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Facility Phone Number: 407 532-3109

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1538316617

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1096614
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ORLANDO PARK DIALYSIS
Street	5397 W COLONIAL DR STE 120
City	ORLANDO
State	FL
ZIP	32808
Phone	407 532-3109
CertificateType	4
CertificateEffectiveDate	3/9/2023
CertificateExpirationDate	3/8/2025
FacilityType	Waiver

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