24D2152574 CLIA NUMBER - PHALEN DIALYSIS

Laboratory Demographics

  • CLIA Code: 24D2152574
  • Facility Name: PHALEN DIALYSIS
  • Facility Address: 862 ARCADE ST
    SAINT PAUL, MN
    ZIP 55106
  • Facility Phone: 651 776-0466
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: ANDREW KUMMER
  • NPI Number: 1902392111
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 24D2152574
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PHALEN DIALYSIS
Street 862 ARCADE ST
City SAINT PAUL
State MN
ZIP 55106
Phone 651 776-0466
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/13/2024
Certificate Expiration Date 8/12/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director ANDREW KUMMER

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