19D0463754 CLIA NUMBER - DIALYSIS CENTER OF SHREVEPORT

Laboratory Demographics

CLIA Number: 19D0463754

Facility Name: DIALYSIS CENTER OF SHREVEPORT

Facility Address:
3949 SOUTHERN AVE
SHREVEPORT, LA
ZIP 71106
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Facility Phone Number: 318 869-3016

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1164534913

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D0463754
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	DIALYSIS CENTER OF SHREVEPORT
Street	3949 SOUTHERN AVE
City	SHREVEPORT
State	LA
ZIP	71106
Phone	318 869-3016
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