10D2161579 CLIA NUMBER - PHILIPS HIGHWAY DIALYSIS

Laboratory Demographics

CLIA Number: 10D2161579

Facility Name: PHILIPS HIGHWAY DIALYSIS

Facility Address:
8021 PHILIPS HWY STE 15
JACKSONVILLE, FL
ZIP 32256
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Facility Phone Number: 904 636-9652

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1043775331

Taxonomy: 261QE0700X - Clinic/Center

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
CertificateType	4
CertificateEffectiveDate	2/6/2023
CertificateExpirationDate	2/5/2025
FacilityType	Waiver

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