32D0713388 CLIA NUMBER - FOUR CORNERS DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 32D0713388

Facility Name: FOUR CORNERS DIALYSIS CENTER

Facility Address:
801 WEST BROADWAY
FARMINGTON, NM
ZIP 87401
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Facility Phone Number: 505 325-2827

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1063477727

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	32D0713388
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FOUR CORNERS DIALYSIS CENTER
Street	801 WEST BROADWAY
City	FARMINGTON
State	NM
ZIP	87401
Phone	505 325-2827
CertificateType	4
CertificateEffectiveDate	2/23/2024
CertificateExpirationDate	2/22/2026
FacilityType	Waiver

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