13D0936397 CLIA NUMBER - TWIN FALLS DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 13D0936397

Facility Name: TWIN FALLS DIALYSIS CENTER

Facility Address:
582 POLE LINE RD
TWIN FALLS, ID
ZIP 83301
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Facility Phone Number: 208 733-2006

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1932150653

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D0936397
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	TWIN FALLS DIALYSIS CENTER
Street	582 POLE LINE RD
City	TWIN FALLS
State	ID
ZIP	83301
Phone	208 733-2006
CertificateType	4
CertificateEffectiveDate	11/20/2023
CertificateExpirationDate	11/19/2025
FacilityType	Waiver

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