15D2022384 CLIA NUMBER - FORT WAYNE WEST DIALYSIS

Laboratory Demographics

  • CLIA Code: 15D2022384
  • Facility Name: FORT WAYNE WEST DIALYSIS
  • Facility Address: 4916 ILLINOIS RD STE 118
    FORT WAYNE, IN
    ZIP 46804
  • Facility Phone: 260 434-0483
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: BADAL RAVAL
  • NPI Number: 1366745630
  • Taxonomy: 261QE0700X - Clinic/Center

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 15D2022384
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name FORT WAYNE WEST DIALYSIS
Street 4916 ILLINOIS RD STE 118
City FORT WAYNE
State IN
ZIP 46804
Phone 260 434-0483
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2025
Certificate Expiration Date 3/31/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director BADAL RAVAL

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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