18D1094938 CLIA NUMBER - SOUTH WILLIAMSON DIALYSIS

Laboratory Demographics

CLIA Number: 18D1094938

Facility Name: SOUTH WILLIAMSON DIALYSIS

Facility Address:
204 APPALACHIAN PLAZA
SOUTH WILLIAMSON, KY
ZIP 41503
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Facility Phone Number: 606 123-4566

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1932351848

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	18D1094938
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SOUTH WILLIAMSON DIALYSIS
Street	204 APPALACHIAN PLAZA
City	SOUTH WILLIAMSON
State	KY
ZIP	41503
Phone	606 123-4566
CertificateType	4
CertificateEffectiveDate	1/29/2023
CertificateExpirationDate	1/28/2025
FacilityType	Waiver

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