24D0951918 CLIA NUMBER - PARK AVENUE DIALYSIS

Laboratory Demographics

  • CLIA Code: 24D0951918
  • Facility Name: PARK AVENUE DIALYSIS
  • Facility Address: 2637 PARK AVENUE
    MINNEAPOLIS, MN
    ZIP 55407
  • Facility Phone: 612 872-1946
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JAMES P. GITTER
  • NPI Number: 1710227103
  • Taxonomy: 103T00000X - Psychologist

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CLIA Record

Field Name Field Value
CLIA Number 24D0951918
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PARK AVENUE DIALYSIS
Street 2637 PARK AVENUE
City MINNEAPOLIS
State MN
ZIP 55407
Phone 612 872-1946
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/30/2024
Certificate Expiration Date 9/29/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director JAMES P. GITTER

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