26D0652047 CLIA NUMBER - DE BALIVIERE DIALYSIS

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Laboratory Demographics

CLIA Number: 26D0652047

Facility Name: DE BALIVIERE DIALYSIS

Facility Address:
324 DEBALIVIERE AVE
SAINT LOUIS, MO
ZIP 63112
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Facility Phone Number: 314 367-9111

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1669434544

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D0652047
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	DE BALIVIERE DIALYSIS
Street	324 DEBALIVIERE AVE
City	SAINT LOUIS
State	MO
ZIP	63112
Phone	314 367-9111
CertificateType	4
CertificateEffectiveDate	9/6/2022
CertificateExpirationDate	9/5/2024
FacilityType	Waiver

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