17D0956050 CLIA NUMBER - WYANDOTTE WEST DIALYSIS

Laboratory Demographics

CLIA Number: 17D0956050

Facility Name: WYANDOTTE WEST DIALYSIS

Facility Address:
11014 HASKELL AVENUE
KANSAS CITY, KS
ZIP 66109
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Facility Phone Number: 913 721-9780

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1902865876

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	17D0956050
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WYANDOTTE WEST DIALYSIS
Street	11014 HASKELL AVENUE
City	KANSAS CITY
State	KS
ZIP	66109
Phone	913 721-9780
CertificateType	4
CertificateEffectiveDate	1/19/2023
CertificateExpirationDate	1/18/2025
FacilityType	Waiver

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