16D1036002 CLIA NUMBER - EAST DES MOINES DIALYSIS

Laboratory Demographics

CLIA Number: 16D1036002

Facility Name: EAST DES MOINES DIALYSIS

Facility Address:
1301 PENNSYLVANIA AVENUE, SUITE 208
DES MOINES, IA
ZIP 50316
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Facility Phone Number: 515 262-5995

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1922075670

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	16D1036002
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	EAST DES MOINES DIALYSIS
Street	1301 PENNSYLVANIA AVENUE, SUITE 208
City	DES MOINES
State	IA
ZIP	50316
Phone	515 262-5995
CertificateType	4
CertificateEffectiveDate	1/18/2023
CertificateExpirationDate	1/17/2025
FacilityType	Waiver

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