45D0986844 CLIA NUMBER - KIDNEY CENTER OF JASPER

Laboratory Demographics

  • CLIA Code: 45D0986844
  • Facility Name: KIDNEY CENTER OF JASPER
  • Facility Address: 930 MARVIN HANCOCK DRIVE
    JASPER, TX
    ZIP 75951
  • Facility Phone: 409 384-4200
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: AJITH KURIAKOSE
  • NPI Number: 1679684567
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D0986844
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name KIDNEY CENTER OF JASPER
Street 930 MARVIN HANCOCK DRIVE
City JASPER
State TX
ZIP 75951
Phone 409 384-4200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/23/2025
Certificate Expiration Date 5/22/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director AJITH KURIAKOSE

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