25D0693216 CLIA NUMBER - FRESENIUS KIDNEY CARE BROOKHAVEN

Laboratory Demographics

CLIA Number: 25D0693216

Facility Name: FRESENIUS KIDNEY CARE BROOKHAVEN

Facility Address:
534 IRBY DRIVE
BROOKHAVEN, MS
ZIP 39601
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Facility Phone Number: 601 833-9720

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1215696745

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D0693216
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FRESENIUS KIDNEY CARE BROOKHAVEN
Street	534 IRBY DRIVE
City	BROOKHAVEN
State	MS
ZIP	39601
Phone	601 833-9720
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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