24D2048442 CLIA NUMBER - DIALYSIS AT MANKATO CLINIC

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Laboratory Demographics

CLIA Number: 24D2048442

Facility Name: DIALYSIS AT MANKATO CLINIC

Facility Address:
1400 MADISON AVENUE
MANKATO, MN
ZIP 56001
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Facility Phone Number: 507 385-0432

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1538414941

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	24D2048442
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	DIALYSIS AT MANKATO CLINIC
Street	1400 MADISON AVENUE
City	MANKATO
State	MN
ZIP	56001
Phone	507 385-0432
CertificateType	4
CertificateEffectiveDate	10/16/2022
CertificateExpirationDate	10/15/2024
FacilityType	Waiver

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