42D1003022 CLIA NUMBER - COLUMBIA NORTHEAST KIDNEY CENTER, LLC

Laboratory Demographics

CLIA Number: 42D1003022

Facility Name: COLUMBIA NORTHEAST KIDNEY CENTER, LLC

Facility Address:
7499 PARKLANE RD
COLUMBIA, SC
ZIP 29223
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Facility Phone Number: 803 865-0554

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1073054847

Taxonomy: 101YP2500X - Counselor

CLIA Record

Field Name	Field Value
CLIA Number	42D1003022
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	COLUMBIA NORTHEAST KIDNEY CENTER, LLC
Street	7499 PARKLANE RD
City	COLUMBIA
State	SC
ZIP	29223
Phone	803 865-0554
CertificateType	4
CertificateEffectiveDate	8/20/2022
CertificateExpirationDate	8/19/2024
FacilityType	Waiver

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