44D2121838 CLIA NUMBER - FORT CAMPBELL DIALYSIS

Laboratory Demographics

CLIA Number: 44D2121838

Facility Name: FORT CAMPBELL DIALYSIS

Facility Address:
1459 FORT CAMPBELL BLVD
CLARKSVILLE, TN
ZIP 37042
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Facility Phone Number: 931 552-6491

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1265983639

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	44D2121838
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FORT CAMPBELL DIALYSIS
Street	1459 FORT CAMPBELL BLVD
City	CLARKSVILLE
State	TN
ZIP	37042
Phone	931 552-6491
CertificateType	4
CertificateEffectiveDate	11/15/2022
CertificateExpirationDate	11/14/2024
FacilityType	Waiver

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