45D1020474 CLIA NUMBER - SOUTHEAST TYLER DIALYSIS

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Laboratory Demographics

CLIA Number: 45D1020474

Facility Name: SOUTHEAST TYLER DIALYSIS

Facility Address:
3826 TROUP HIGHWAY SUITE L
TYLER, TX
ZIP 75701
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Facility Phone Number: 903 531-9498

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1801998224

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D1020474
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	SOUTHEAST TYLER DIALYSIS
Street	3826 TROUP HIGHWAY SUITE L
City	TYLER
State	TX
ZIP	75701
Phone	903 531-9498
CertificateType	4
CertificateEffectiveDate	12/22/2023
CertificateExpirationDate	12/21/2025
FacilityType	Waiver

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