15D2048268 CLIA NUMBER - VINCENNES HOME DIALYSIS

Laboratory Demographics

  • CLIA Code: 15D2048268
  • Facility Name: VINCENNES HOME DIALYSIS
  • Facility Address: 700 WILLOW ST, STE 102
    VINCENNES, IN
    ZIP 47591
  • Facility Phone: 812 886-9034
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: RAFAEL LAO
  • NPI Number: 1164773180
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2048268
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name VINCENNES HOME DIALYSIS
Street 700 WILLOW ST, STE 102
City VINCENNES
State IN
ZIP 47591
Phone 812 886-9034
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/12/2024
Certificate Expiration Date 10/11/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director RAFAEL LAO

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