17D2080175 CLIA NUMBER - GARDNER DIALYSIS

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Laboratory Demographics

CLIA Number: 17D2080175

Facility Name: GARDNER DIALYSIS

Facility Address:
328 EAST MAIN STREET
GARDNER, KS
ZIP 66030
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Facility Phone Number: 913 884-8488

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1457762692

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	17D2080175
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	GARDNER DIALYSIS
Street	328 EAST MAIN STREET
City	GARDNER
State	KS
ZIP	66030
Phone	913 884-8488
CertificateType	4
CertificateEffectiveDate	7/1/2022
CertificateExpirationDate	6/30/2024
FacilityType	Waiver

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