34D1092234 CLIA NUMBER - MILLER ST DIALYSIS CTR OF WAKE FOREST UNIVERSITY

Laboratory Demographics

CLIA Number: 34D1092234

Facility Name: MILLER ST DIALYSIS CTR OF WAKE FOREST UNIVERSITY

Facility Address:
120 MILLER STREET
WINSTON-SALEM, NC
ZIP 27103
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Facility Phone Number: 336 721-4801

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1407000540

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	34D1092234
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MILLER ST DIALYSIS CTR OF WAKE FOREST UNIVERSITY
Street	120 MILLER STREET
City	WINSTON-SALEM
State	NC
ZIP	27103
Phone	336 721-4801
CertificateType	4
CertificateEffectiveDate	11/20/2022
CertificateExpirationDate	11/19/2024
FacilityType	Waiver

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