14D2058344 CLIA NUMBER - TAZEWELL COUNTY DIALYSIS (DBA) PEKIN DIALYSIS L L C

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Laboratory Demographics

CLIA Number: 14D2058344

Facility Name: TAZEWELL COUNTY DIALYSIS (DBA) PEKIN DIALYSIS L L C

Facility Address:
1021 COURT ST
PEKIN, IL
ZIP 61554
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Facility Phone Number: 309 478-1000

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1619218732

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	14D2058344
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	TAZEWELL COUNTY DIALYSIS (DBA) PEKIN DIALYSIS L L C
Street	1021 COURT ST
City	PEKIN
State	IL
ZIP	61554
Phone	309 478-1000
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