10D2161579 CLIA NUMBER - PHILIPS HIGHWAY DIALYSIS

Laboratory Demographics

  • CLIA Code: 10D2161579
  • Facility Name: PHILIPS HIGHWAY DIALYSIS
  • Facility Address: 8021 PHILIPS HWY STE 15
    JACKSONVILLE, FL
    ZIP 32256
  • Facility Phone: 904 636-9652
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JAGAN KOTHAPALLY
  • NPI Number: 1043775331
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2161579
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PHILIPS HIGHWAY DIALYSIS
Street 8021 PHILIPS HWY STE 15
City JACKSONVILLE
State FL
ZIP 32256
Phone 904 636-9652
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2025
Certificate Expiration Date 2/5/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director JAGAN KOTHAPALLY

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This page was last updated on: 9/29/2025