28D0978174 CLIA NUMBER - OVERLAND TRAILS RENAL CARE GROUP, LLC

Laboratory Demographics

CLIA Number: 28D0978174

Facility Name: OVERLAND TRAILS RENAL CARE GROUP, LLC

Facility Address:
5210 PARKLANE DRIVE
KEARNEY, NE
ZIP 68847
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Facility Phone Number: 308 233-5011

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1730291543

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	28D0978174
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	OVERLAND TRAILS RENAL CARE GROUP, LLC
Street	5210 PARKLANE DRIVE
City	KEARNEY
State	NE
ZIP	68847
Phone	308 233-5011
CertificateType	4
CertificateEffectiveDate	9/18/2022
CertificateExpirationDate	9/17/2024
FacilityType	Waiver

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