10D2193610 CLIA NUMBER - 5072020, LLC

Laboratory Demographics

  • CLIA Code: 10D2193610
  • Facility Name: 5072020, LLC
  • Facility Address: 2675 WINKLER AVE STE 130
    FORT MYERS, FL
    ZIP 33901
  • Facility Phone: 239 791-1747
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: GAUTHAM MOGILISHETTY
  • NPI Number: 1538773411
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2193610
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name 5072020, LLC
Street 2675 WINKLER AVE STE 130
City FORT MYERS
State FL
ZIP 33901
Phone 239 791-1747
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2024
Certificate Expiration Date 9/22/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director GAUTHAM MOGILISHETTY

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