17D2104124 CLIA NUMBER - FREE STATE DIALYSIS

Laboratory Demographics

CLIA Number: 17D2104124

Facility Name: FREE STATE DIALYSIS

Facility Address:
1918 E 23RD ST
LAWRENCE, KS
ZIP 66046
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Facility Phone Number: 785 312-9377

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1962871012

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	17D2104124
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FREE STATE DIALYSIS
Street	1918 E 23RD ST
City	LAWRENCE
State	KS
ZIP	66046
Phone	785 312-9377
CertificateType	4
CertificateEffectiveDate	10/28/2023
CertificateExpirationDate	10/27/2025
FacilityType	Waiver

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