34D1086190 CLIA NUMBER - CROOKED CREEK DIALYSIS

Laboratory Demographics

  • CLIA Code: 34D1086190
  • Facility Name: CROOKED CREEK DIALYSIS
  • Facility Address: 6070 W HIGHWAY 74
    INDIAN TRAIL, NC
    ZIP 28079
  • Facility Phone: 980 446-1305
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MICHAEL E. ETOMI
  • NPI Number: 1548724669
  • Taxonomy: 261QD0000X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 34D1086190
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name CROOKED CREEK DIALYSIS
Street 6070 W HIGHWAY 74
City INDIAN TRAIL
State NC
ZIP 28079
Phone 980 446-1305
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/8/2024
Certificate Expiration Date 7/7/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MICHAEL E. ETOMI

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This page was last updated on: 9/29/2025