19D0982794 CLIA NUMBER - FMC DIALYSIS SERVICES BREAUX BRIDGE

Laboratory Demographics

CLIA Number: 19D0982794

Facility Name: FMC DIALYSIS SERVICES BREAUX BRIDGE

Facility Address:
100 CHAMPAGNE BOULEVARD, BLDG A
BREAUX BRIDGE, LA
ZIP 70517
Get Directions

Facility Phone Number: 337 332-6813

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1700998580

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	19D0982794
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FMC DIALYSIS SERVICES BREAUX BRIDGE
Street	100 CHAMPAGNE BOULEVARD, BLDG A
City	BREAUX BRIDGE
State	LA
ZIP	70517
Phone	337 332-6813
CertificateType	4
CertificateEffectiveDate	2/5/2023
CertificateExpirationDate	2/4/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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