10D2055051 CLIA NUMBER - KIDNEY KARE OF JACKSONVILLE INC

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Laboratory Demographics

CLIA Number: 10D2055051

Facility Name: KIDNEY KARE OF JACKSONVILLE INC

Facility Address:
4168 SOUTHPOINT PKWY STE 103
JACKSONVILLE, FL
ZIP 32216
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Facility Phone Number: 904 332-8004

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1114284494

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2055051
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	KIDNEY KARE OF JACKSONVILLE INC
Street	4168 SOUTHPOINT PKWY STE 103
City	JACKSONVILLE
State	FL
ZIP	32216
Phone	904 332-8004
CertificateType	4
CertificateEffectiveDate	3/5/2023
CertificateExpirationDate	3/4/2025
FacilityType	Waiver

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