23D0979240 CLIA NUMBER - PHYSICIANS DIALYSIS GRAND RAPIDS EAST

Laboratory Demographics

  • CLIA Code: 23D0979240
  • Facility Name: PHYSICIANS DIALYSIS GRAND RAPIDS EAST
  • Facility Address: 1230 EKHART STREET, NE
    GRAND RAPIDS, MI
    ZIP 49503
  • Facility Phone: 616 742-8930
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JEANIE M. GRATIOT-DEANS
  • NPI Number: 1568424455
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 23D0979240
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PHYSICIANS DIALYSIS GRAND RAPIDS EAST
Street 1230 EKHART STREET, NE
City GRAND RAPIDS
State MI
ZIP 49503
Phone 616 742-8930
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/17/2024
Certificate Expiration Date 10/16/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director JEANIE M. GRATIOT-DEANS

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This page was last updated on: 9/29/2025