17D2051501 CLIA NUMBER - ANDOVER DIALYSIS

Laboratory Demographics

  • CLIA Code: 17D2051501
  • Facility Name: ANDOVER DIALYSIS
  • Facility Address: 626 SOUTH ANDOVER ROAD SUITE 900
    ANDOVER, KS
    ZIP 67002
  • Facility Phone: (316) 733-2984
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JANY MOUSSA
  • NPI Number: 1679817258
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 17D2051501
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name ANDOVER DIALYSIS
Street 626 SOUTH ANDOVER ROAD SUITE 900
City ANDOVER
State KS
ZIP 67002
Phone 3167332984
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/19/2024
Certificate Expiration Date 12/18/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director JANY MOUSSA

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This page was last updated on: 5/18/2026