39D0906590 CLIA NUMBER - MEMPHIS STREET RENAL CENTER

Laboratory Demographics

CLIA Number: 39D0906590

Facility Name: MEMPHIS STREET RENAL CENTER

Facility Address:
3310 - 24 MEMPHIS STREET
PHILADELPHIA, PA
ZIP 19134
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Facility Phone Number: 215 739-9558

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1376580464

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D0906590
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	MEMPHIS STREET RENAL CENTER
Street	3310 - 24 MEMPHIS STREET
City	PHILADELPHIA
State	PA
ZIP	19134
Phone	215 739-9558
CertificateType	4
CertificateEffectiveDate	10/3/2023
CertificateExpirationDate	10/2/2025
FacilityType	Waiver

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