15D2124895 CLIA NUMBER - BRAZIL DIALYSIS

Laboratory Demographics

CLIA Number: 15D2124895

Facility Name: BRAZIL DIALYSIS

Facility Address:
115 S MURPHY AVE
BRAZIL, IN
ZIP 47834
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Facility Phone Number: 812 442-8481

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1083163406

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	15D2124895
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	BRAZIL DIALYSIS
Street	115 S MURPHY AVE
City	BRAZIL
State	IN
ZIP	47834
Phone	812 442-8481
CertificateType	4
CertificateEffectiveDate	1/27/2023
CertificateExpirationDate	1/26/2025
FacilityType	Waiver

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