10D2228830 CLIA NUMBER - ARA SOUTHSIDE DIALYSIS, LLC

Laboratory Demographics

CLIA Number: 10D2228830

Facility Name: ARA SOUTHSIDE DIALYSIS, LLC

Facility Address:
12735 GRAN BAY PKWY W STE 210
JACKSONVILLE, FL
ZIP 32258
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Facility Phone Number: 904 659-6999

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1720662489

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2228830
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ARA SOUTHSIDE DIALYSIS, LLC
Street	12735 GRAN BAY PKWY W STE 210
City	JACKSONVILLE
State	FL
ZIP	32258
Phone	904 659-6999
CertificateType	4
CertificateEffectiveDate	7/1/2023
CertificateExpirationDate	6/30/2025
FacilityType	Waiver

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