43D0908528 CLIA NUMBER - PORCUPINE DIALYSIS UNIT DIALYSIS MANAGMENT GROUP LLC

Laboratory Demographics

  • CLIA Code: 43D0908528
  • Facility Name: PORCUPINE DIALYSIS UNIT DIALYSIS MANAGMENT GROUP LLC
  • Facility Address: MAIN STREET HCR 49 BOX 82C
    PORCUPINE, SD
    ZIP 57772
  • Facility Phone: 605 867-1405
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: BETTY G. COX
  • NPI Number: 1922318666
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 43D0908528
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PORCUPINE DIALYSIS UNIT DIALYSIS MANAGMENT GROUP LLC
Street MAIN STREET HCR 49 BOX 82C
City PORCUPINE
State SD
ZIP 57772
Phone 605 867-1405
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/22/2024
Certificate Expiration Date 11/21/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director BETTY G. COX

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This page was last updated on: 9/29/2025