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39D2062166 CLIA NUMBER - CITY LINE DIALYSIS

Laboratory Demographics

CLIA Number: 39D2062166

Facility Name: CITY LINE DIALYSIS

Facility Address:
4508 CITY LINE AVE
PHILADELPHIA, PA
ZIP 19131
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Facility Phone Number: 215 473-3071

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver
NPI Number: 1396199881

Taxonomy: 207Y00000X - Otolaryngology
An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.

CLIA Record

Field Name Field Value
CLIA Number 39D2062166
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name CITY LINE DIALYSIS
Street 4508 CITY LINE AVE
City PHILADELPHIA
State PA
ZIP 19131
Phone 215 473-3071
CertificateType 4
CertificateEffectiveDate 7/11/2023
CertificateExpirationDate 7/10/2025
FacilityType Waiver

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