36D2245129 CLIA NUMBER - PIKE PLACE DIALYSIS

Laboratory Demographics

  • CLIA Code: 36D2245129
  • Facility Name: PIKE PLACE DIALYSIS
  • Facility Address: 2801 WILMINGTON PIKE
    KETTERING, OH
    ZIP 45419
  • Facility Phone: 937 637-4633
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MADHU KANDARPA
  • NPI Number: 1902558471
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 36D2245129
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PIKE PLACE DIALYSIS
Street 2801 WILMINGTON PIKE
City KETTERING
State OH
ZIP 45419
Phone 937 637-4633
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/9/2023
Certificate Expiration Date 12/8/2025
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MADHU KANDARPA

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