45D0947556 CLIA NUMBER - WEST TYLER DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 45D0947556

Facility Name: WEST TYLER DIALYSIS CENTER

Facility Address:
3600 WEST ERWIN
TYLER, TX
ZIP 75702
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Facility Phone Number: 903 592-6288

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1245342120

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D0947556
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WEST TYLER DIALYSIS CENTER
Street	3600 WEST ERWIN
City	TYLER
State	TX
ZIP	75702
Phone	903 592-6288
CertificateType	4
CertificateEffectiveDate	6/18/2022
CertificateExpirationDate	6/17/2024
FacilityType	Waiver

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