38D1058639 CLIA NUMBER - MERIDIAN PARK DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 38D1058639

Facility Name: MERIDIAN PARK DIALYSIS CENTER

Facility Address:
19255 SW 65TH AVENUE SUITE 100
TUALATIN, OR
ZIP 97062
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Facility Phone Number: 503 692-8159

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1659312734

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	38D1058639
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MERIDIAN PARK DIALYSIS CENTER
Street	19255 SW 65TH AVENUE SUITE 100
City	TUALATIN
State	OR
ZIP	97062
Phone	503 692-8159
CertificateType	4
CertificateEffectiveDate	9/11/2022
CertificateExpirationDate	9/10/2024
FacilityType	Waiver

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