17D2165245 CLIA NUMBER - WALNUT RIVER DIALYSIS

Laboratory Demographics

  • CLIA Code: 17D2165245
  • Facility Name: WALNUT RIVER DIALYSIS
  • Facility Address: 701 W CENTRAL AVE
    EL DORADO, KS
    ZIP 67042
  • Facility Phone: 316 322-4541
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: RONNIE MOUSSA
  • NPI Number: 1639630957
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 17D2165245
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name WALNUT RIVER DIALYSIS
Street 701 W CENTRAL AVE
City EL DORADO
State KS
ZIP 67042
Phone 316 322-4541
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director RONNIE MOUSSA

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This page was last updated on: 9/29/2025