10D2103612 CLIA NUMBER - WEST ORANGE MAITLAND DIALYSIS CENTER LLC

Laboratory Demographics

CLIA Number: 10D2103612

Facility Name: WEST ORANGE MAITLAND DIALYSIS CENTER LLC

Facility Address:
7960 FOREST CITY ROAD STE 105
ORLANDO, FL
ZIP 32810
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Facility Phone Number: 407 297-8408

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1578534749

Taxonomy: 207RN0300X - Internal Medicine
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.

CLIA Record

Field Name	Field Value
CLIA Number	10D2103612
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WEST ORANGE MAITLAND DIALYSIS CENTER LLC
Street	7960 FOREST CITY ROAD STE 105
City	ORLANDO
State	FL
ZIP	32810
Phone	407 297-8408
CertificateType	4
CertificateEffectiveDate	10/16/2023
CertificateExpirationDate	10/15/2025
FacilityType	Waiver

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