34D0667479 CLIA NUMBER - MT AIRY DIALYSIS CENTER OF WAKE FOREST UNIVERSITY

Laboratory Demographics

CLIA Number: 34D0667479

Facility Name: MT AIRY DIALYSIS CENTER OF WAKE FOREST UNIVERSITY

Facility Address:
1280 NEWSOME STREET
MT AIRY, NC
ZIP 27030
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Facility Phone Number: 336 789-4090

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1982681904

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D0667479
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MT AIRY DIALYSIS CENTER OF WAKE FOREST UNIVERSITY
Street	1280 NEWSOME STREET
City	MT AIRY
State	NC
ZIP	27030
Phone	336 789-4090
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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