10D2289344 CLIA NUMBER - LAKE SUMTER DIALYSIS AT THE VILLAGES

Laboratory Demographics

CLIA Number: 10D2289344

Facility Name: LAKE SUMTER DIALYSIS AT THE VILLAGES

Facility Address:
1050 OLD CAMP RD SUITE 130
THE VILLAGES, FL
ZIP 32162
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Facility Phone Number: 352 743-2001

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1497443832

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2289344
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	LAKE SUMTER DIALYSIS AT THE VILLAGES
Street	1050 OLD CAMP RD SUITE 130
City	THE VILLAGES
State	FL
ZIP	32162
Phone	352 743-2001
CertificateType	4
CertificateEffectiveDate	9/8/2023
CertificateExpirationDate	9/7/2025
FacilityType	Waiver

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