10D2029451 CLIA NUMBER - MEMORIAL PLAZA DIALYSIS

Laboratory Demographics

  • CLIA Code: 10D2029451
  • Facility Name: MEMORIAL PLAZA DIALYSIS
  • Facility Address: 3901 UNIVERSITY BLVD S STE 111
    JACKSONVILLE, FL
    ZIP 32216
  • Facility Phone: 904 731-0247
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: KOTESWARI KANCHA
  • NPI Number: 1831477173
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2029451
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MEMORIAL PLAZA DIALYSIS
Street 3901 UNIVERSITY BLVD S STE 111
City JACKSONVILLE
State FL
ZIP 32216
Phone 904 731-0247
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/8/2025
Certificate Expiration Date 9/7/2027
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