14D2043478 CLIA NUMBER - DRIFTWOOD DIALYSIS (DBA) FREEPORTBAY DIALYSIS LLC

Laboratory Demographics

  • CLIA Code: 14D2043478
  • Facility Name: DRIFTWOOD DIALYSIS (DBA) FREEPORTBAY DIALYSIS LLC
  • Facility Address: 1808 S WEST AVE
    FREEPORT, IL
    ZIP 61032
  • Facility Phone: 815 232-0295
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: KHAN FARHAN
  • NPI Number: 1225300056
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2043478
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name DRIFTWOOD DIALYSIS (DBA) FREEPORTBAY DIALYSIS LLC
Street 1808 S WEST AVE
City FREEPORT
State IL
ZIP 61032
Phone 815 232-0295
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/3/2024
Certificate Expiration Date 7/2/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director KHAN FARHAN

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This page was last updated on: 9/29/2025