14D0723759 CLIA NUMBER - EFFINGHAM DIALYSIS

Laboratory Demographics

CLIA Number: 14D0723759

Facility Name: EFFINGHAM DIALYSIS

Facility Address:
904 MEDICAL PARK DRIVE SUITE 1
EFFINGHAM, IL
ZIP 62401
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Facility Phone Number: 217 342-9558

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1245290782

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D0723759
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	EFFINGHAM DIALYSIS
Street	904 MEDICAL PARK DRIVE SUITE 1
City	EFFINGHAM
State	IL
ZIP	62401
Phone	217 342-9558
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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