39D2167169 CLIA NUMBER - NCPDC KIDNEY CENTER

Laboratory Demographics

CLIA Number: 39D2167169

Facility Name: NCPDC KIDNEY CENTER

Facility Address:
1201 GRAMPIAN BOULEVARD, SUITE 1B
WILLIAMSPORT, PA
ZIP 17701
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Facility Phone Number: 570 478-5228

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1528424975

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D2167169
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	NCPDC KIDNEY CENTER
Street	1201 GRAMPIAN BOULEVARD, SUITE 1B
City	WILLIAMSPORT
State	PA
ZIP	17701
Phone	570 478-5228
CertificateType	4
CertificateEffectiveDate	6/4/2023
CertificateExpirationDate	6/3/2025
FacilityType	Waiver

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