10D2052506 CLIA NUMBER - PALATKA DIALYSIS

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Laboratory Demographics

CLIA Number: 10D2052506

Facility Name: PALATKA DIALYSIS

Facility Address:
326 ZEAGLER DR
PALATKA, FL
ZIP 32177
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Facility Phone Number: 386 329-9458

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1124378518

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2052506
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	PALATKA DIALYSIS
Street	326 ZEAGLER DR
City	PALATKA
State	FL
ZIP	32177
Phone	386 329-9458
CertificateType	4
CertificateEffectiveDate	1/11/2023
CertificateExpirationDate	1/10/2025
FacilityType	Waiver

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