10D2029451 CLIA NUMBER - MEMORIAL PLAZA DIALYSIS

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Laboratory Demographics

CLIA Number: 10D2029451

Facility Name: MEMORIAL PLAZA DIALYSIS

Facility Address:
3901 UNIVERSITY BLVD S STE 111
JACKSONVILLE, FL
ZIP 32216
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Facility Phone Number: 904 731-0247

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1831477173

Taxonomy: 261QE0700X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	9/8/2023
CertificateExpirationDate	9/7/2025
FacilityType	Waiver

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