19D0649270 CLIA NUMBER - BOSSIER REGIONAL DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 19D0649270

Facility Name: BOSSIER REGIONAL DIALYSIS CENTER

Facility Address:
2907 PLANTATION DRIVE
BOSSIER CITY, LA
ZIP 71111
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Facility Phone Number: 318 746-8440

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1245342096

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D0649270
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	BOSSIER REGIONAL DIALYSIS CENTER
Street	2907 PLANTATION DRIVE
City	BOSSIER CITY
State	LA
ZIP	71111
Phone	318 746-8440
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