34D1023455 CLIA NUMBER - SOUTHERN PINES DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 34D1023455

Facility Name: SOUTHERN PINES DIALYSIS CENTER

Facility Address:
209 WINDSTAR PLACE
SOUTHERN PINES, NC
ZIP 28387
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Facility Phone Number: 910 692-6218

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1467411199

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D1023455
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SOUTHERN PINES DIALYSIS CENTER
Street	209 WINDSTAR PLACE
City	SOUTHERN PINES
State	NC
ZIP	28387
Phone	910 692-6218
CertificateType	4
CertificateEffectiveDate	3/17/2024
CertificateExpirationDate	3/16/2026
FacilityType	Waiver

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