34D0901606 CLIA NUMBER - SOUTHEASTERN DIALYSIS CENTER-SHALLOTTE

Laboratory Demographics

CLIA Number: 34D0901606

Facility Name: SOUTHEASTERN DIALYSIS CENTER-SHALLOTTE

Facility Address:
4770 SHALLOTTE AVENUE
SHALLOTTE, NC
ZIP 28470
Get Directions

Facility Phone Number: 910 754-5563

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1184683567

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D0901606
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SOUTHEASTERN DIALYSIS CENTER-SHALLOTTE
Street	4770 SHALLOTTE AVENUE
City	SHALLOTTE
State	NC
ZIP	28470
Phone	910 754-5563
CertificateType	4
CertificateEffectiveDate	7/3/2022
CertificateExpirationDate	7/2/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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