10D2108612 CLIA NUMBER - FRESENIUS MEDICAL CARE LAKE CITY HOME

Laboratory Demographics

CLIA Number: 10D2108612

Facility Name: FRESENIUS MEDICAL CARE LAKE CITY HOME

Facility Address:
215 SW PROSPERITY PL STE 101
LAKE CITY, FL
ZIP 32024
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Facility Phone Number: 386 758-2202

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1629443130

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2108612
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FRESENIUS MEDICAL CARE LAKE CITY HOME
Street	215 SW PROSPERITY PL STE 101
City	LAKE CITY
State	FL
ZIP	32024
Phone	386 758-2202
CertificateType	4
CertificateEffectiveDate	2/9/2024
CertificateExpirationDate	2/8/2026
FacilityType	Waiver

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