26D1106374 CLIA NUMBER - HANNIBAL DIALYSIS

Laboratory Demographics

  • CLIA Code: 26D1106374
  • Facility Name: HANNIBAL DIALYSIS
  • Facility Address: 119 PRGRESS ROAD
    HANNIBAL, MO
    ZIP 63401
  • Facility Phone: 573 406-0165
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: PRASHANTH W. PODARALLA
  • NPI Number: 1265767628
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 26D1106374
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name HANNIBAL DIALYSIS
Street 119 PRGRESS ROAD
City HANNIBAL
State MO
ZIP 63401
Phone 573 406-0165
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/13/2025
Certificate Expiration Date 10/12/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director PRASHANTH W. PODARALLA

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