37D2121594 CLIA NUMBER - WAGONER DIALYSIS SHADE DIALYSIS

Laboratory Demographics

  • CLIA Code: 37D2121594
  • Facility Name: WAGONER DIALYSIS SHADE DIALYSIS
  • Facility Address: 402 S WALL ST
    WAGONER, OK
    ZIP 74467
  • Facility Phone: 918 485-4363
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: AZADI REZA MD
  • NPI Number: 1215483862
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 37D2121594
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name WAGONER DIALYSIS SHADE DIALYSIS
Street 402 S WALL ST
City WAGONER
State OK
ZIP 74467
Phone 918 485-4363
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2024
Certificate Expiration Date 11/7/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director AZADI REZA MD

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