19D0463641 CLIA NUMBER - SHREVEPORT REGIONAL DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 19D0463641

Facility Name: SHREVEPORT REGIONAL DIALYSIS CENTER

Facility Address:
1130 KINGS HIGHWAY
SHREVEPORT, LA
ZIP 71104
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Facility Phone Number: 318 670-5387

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1427160274

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D0463641
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SHREVEPORT REGIONAL DIALYSIS CENTER
Street	1130 KINGS HIGHWAY
City	SHREVEPORT
State	LA
ZIP	71104
Phone	318 670-5387
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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