26D1043373 CLIA NUMBER - RTC-COLUMBIA DIALYSIS

Laboratory Demographics

CLIA Number: 26D1043373

Facility Name: RTC-COLUMBIA DIALYSIS

Facility Address:
1701 E BROADWAY, STE G02
COLUMBIA, MO
ZIP 65201
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Facility Phone Number: 573 442-0573

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1629039300

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D1043373
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	RTC-COLUMBIA DIALYSIS
Street	1701 E BROADWAY, STE G02
City	COLUMBIA
State	MO
ZIP	65201
Phone	573 442-0573
CertificateType	4
CertificateEffectiveDate	7/22/2023
CertificateExpirationDate	7/21/2025
FacilityType	Waiver

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