13D1101987 CLIA NUMBER - MOSCOW DIALYSIS CENTER

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Laboratory Demographics

CLIA Number: 13D1101987

Facility Name: MOSCOW DIALYSIS CENTER

Facility Address:
212 RODEO DR #110
MOSCOW, ID
ZIP 83843
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Facility Phone Number: 208 882-5925

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1225265606

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D1101987
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MOSCOW DIALYSIS CENTER
Street	212 RODEO DR #110
City	MOSCOW
State	ID
ZIP	83843
Phone	208 882-5925
CertificateType	4
CertificateEffectiveDate	7/9/2023
CertificateExpirationDate	7/8/2025
FacilityType	Waiver

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