22D0965264 CLIA NUMBER - FMC DIALYSIS SERVICES BLACKSTONE VALLEY

Laboratory Demographics

CLIA Number: 22D0965264

Facility Name: FMC DIALYSIS SERVICES BLACKSTONE VALLEY

Facility Address:
42 CAPE ROAD PLAZA
MILFORD, MA
ZIP 01757
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Facility Phone Number: 508 634-4331

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1417966128

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	22D0965264
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FMC DIALYSIS SERVICES BLACKSTONE VALLEY
Street	42 CAPE ROAD PLAZA
City	MILFORD
State	MA
ZIP	01757
Phone	508 634-4331
CertificateType	4
CertificateEffectiveDate	9/16/2023
CertificateExpirationDate	9/15/2025
FacilityType	Waiver

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