15D2022385 CLIA NUMBER - FORT WAYNE SOUTH DIALYSIS

Laboratory Demographics

  • CLIA Code: 15D2022385
  • Facility Name: FORT WAYNE SOUTH DIALYSIS
  • Facility Address: 302 E PETTIT AVE
    FORT WAYNE, IN
    ZIP 46806
  • Facility Phone: 260 456-0451
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: IRFAN MUNIR
  • NPI Number: 1003119876
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2022385
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name FORT WAYNE SOUTH DIALYSIS
Street 302 E PETTIT AVE
City FORT WAYNE
State IN
ZIP 46806
Phone 260 456-0451
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 IRFAN MUNIR

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