15D2106423 CLIA NUMBER - THREE RIVERS DIALYSIS

Laboratory Demographics

  • CLIA Code: 15D2106423
  • Facility Name: THREE RIVERS DIALYSIS
  • Facility Address: 6721 OLD TRAIL RD
    FORT WAYNE, IN
    ZIP 46809
  • Facility Phone: 260 478-8582
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: BADAL RAVAL
  • NPI Number: 1659796233
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 15D2106423
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name THREE RIVERS DIALYSIS
Street 6721 OLD TRAIL RD
City FORT WAYNE
State IN
ZIP 46809
Phone 260 478-8582
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2023
Certificate Expiration Date 12/16/2025
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director BADAL RAVAL

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