13D2058331 CLIA NUMBER - MAGIC VALLEY KIDNEY CENTER

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Laboratory Demographics

CLIA Number: 13D2058331

Facility Name: MAGIC VALLEY KIDNEY CENTER

Facility Address:
350 N HAVEN DR
TWIN FALLS, ID
ZIP 83301
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Facility Phone Number: 208 735-3914

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1154669695

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	13D2058331
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MAGIC VALLEY KIDNEY CENTER
Street	350 N HAVEN DR
City	TWIN FALLS
State	ID
ZIP	83301
Phone	208 735-3914
CertificateType	4
CertificateEffectiveDate	5/6/2023
CertificateExpirationDate	5/5/2025
FacilityType	Waiver

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