23D0949630 CLIA NUMBER - JACKSON DIALYSIS

Laboratory Demographics

CLIA Number: 23D0949630

Facility Name: JACKSON DIALYSIS

Facility Address:
234 W LOUIS GLICK HWY SUITE 100
JACKSON, MI
ZIP 49201
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Facility Phone Number: 517 841-1712

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1952362469

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D0949630
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	JACKSON DIALYSIS
Street	234 W LOUIS GLICK HWY SUITE 100
City	JACKSON
State	MI
ZIP	49201
Phone	517 841-1712
CertificateType	4
CertificateEffectiveDate	8/6/2022
CertificateExpirationDate	8/5/2024
FacilityType	Waiver

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