18D0988741 CLIA NUMBER - PAINTSVILLE DIALYSIS

Laboratory Demographics

CLIA Number: 18D0988741

Facility Name: PAINTSVILLE DIALYSIS

Facility Address:
4750 KY ROUTE 321 SOUTH
HAGERHILL, KY
ZIP 41222
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Facility Phone Number: 606 789-1101

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1740240183

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D0988741
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	PAINTSVILLE DIALYSIS
Street	4750 KY ROUTE 321 SOUTH
City	HAGERHILL
State	KY
ZIP	41222
Phone	606 789-1101
CertificateType	4
CertificateEffectiveDate	7/6/2023
CertificateExpirationDate	7/5/2025
FacilityType	Waiver

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