37D0865740 CLIA NUMBER - LAWTON DIALYSIS CENTER, LLC

Laboratory Demographics

CLIA Number: 37D0865740

Facility Name: LAWTON DIALYSIS CENTER, LLC

Facility Address:
5110 WEST GORE BLVD, SUITES 1 & 2
LAWTON, OK
ZIP 73505
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Facility Phone Number: 978 675-5186

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1922518448

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	37D0865740
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	LAWTON DIALYSIS CENTER, LLC
Street	5110 WEST GORE BLVD, SUITES 1 & 2
City	LAWTON
State	OK
ZIP	73505
Phone	978 675-5186
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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