42D0676342 CLIA NUMBER - UPSTATE DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 42D0676342

Facility Name: UPSTATE DIALYSIS CENTER

Facility Address:
308 MILLS AVE
GREENVILLE, SC
ZIP 29605
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Facility Phone Number: 864 271-3700

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1043272065

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	42D0676342
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	UPSTATE DIALYSIS CENTER
Street	308 MILLS AVE
City	GREENVILLE
State	SC
ZIP	29605
Phone	864 271-3700
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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