39D1003336 CLIA NUMBER - PHYSICIANS DIALYSIS INC

Laboratory Demographics

CLIA Number: 39D1003336

Facility Name: PHYSICIANS DIALYSIS INC

Facility Address:
834 WALNUT STREET WALNUT TOWERS
PHILADELPHIA, PA
ZIP 19107
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Facility Phone Number: 215 629-1490

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1396707113

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D1003336
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	PHYSICIANS DIALYSIS INC
Street	834 WALNUT STREET WALNUT TOWERS
City	PHILADELPHIA
State	PA
ZIP	19107
Phone	215 629-1490
CertificateType	4
CertificateEffectiveDate	2/2/2023
CertificateExpirationDate	2/1/2025
FacilityType	Waiver

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