15D0876295 CLIA NUMBER - JASPER DIALYSIS

Laboratory Demographics

CLIA Number: 15D0876295

Facility Name: JASPER DIALYSIS

Facility Address:
671 3RD AVE STE A
JASPER, IN
ZIP 47546
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Facility Phone Number: 812 482-3205

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1114983046

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D0876295
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	JASPER DIALYSIS
Street	671 3RD AVE STE A
City	JASPER
State	IN
ZIP	47546
Phone	812 482-3205
CertificateType	4
CertificateEffectiveDate	4/13/2024
CertificateExpirationDate	4/12/2026
FacilityType	Waiver

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