36D2126024 CLIA NUMBER - MALLORY PARK DIALYSIS

Laboratory Demographics

  • CLIA Code: 36D2126024
  • Facility Name: MALLORY PARK DIALYSIS
  • Facility Address: 2808 GERMANTOWN ST
    DAYTON, OH
    ZIP 45417
  • Facility Phone: 937 262-8427
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SAMPATH THIRUVEEDI
  • NPI Number: 1336682707
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 36D2126024
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MALLORY PARK DIALYSIS
Street 2808 GERMANTOWN ST
City DAYTON
State OH
ZIP 45417
Phone 937 262-8427
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/17/2025
Certificate Expiration Date 2/16/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SAMPATH THIRUVEEDI

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