24D0920748 CLIA NUMBER - WYOMING DIALYSIS

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Laboratory Demographics

CLIA Number: 24D0920748

Facility Name: WYOMING DIALYSIS

Facility Address:
5657 257TH STREET, SUITE 400
WYOMING, MN
ZIP 55092
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Facility Phone Number: 651 408-8938

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1417911918

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	24D0920748
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WYOMING DIALYSIS
Street	5657 257TH STREET, SUITE 400
City	WYOMING
State	MN
ZIP	55092
Phone	651 408-8938
CertificateType	4
CertificateEffectiveDate	10/28/2023
CertificateExpirationDate	10/27/2025
FacilityType	Waiver

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