25D1003049 CLIA NUMBER - FRESENIUS KIDNEY CARE - PORT GIBSON

Laboratory Demographics

CLIA Number: 25D1003049

Facility Name: FRESENIUS KIDNEY CARE - PORT GIBSON

Facility Address:
105 CHINQUEPIN STREET
PORT GIBSON, MS
ZIP 39150
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Facility Phone Number: 601 437-3707

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1487766234

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	25D1003049
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FRESENIUS KIDNEY CARE - PORT GIBSON
Street	105 CHINQUEPIN STREET
City	PORT GIBSON
State	MS
ZIP	39150
Phone	601 437-3707
CertificateType	4
CertificateEffectiveDate	8/21/2022
CertificateExpirationDate	8/20/2024
FacilityType	Waiver

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