45D1034970 CLIA NUMBER - PINECREST DIALYSIS

Laboratory Demographics

CLIA Number: 45D1034970

Facility Name: PINECREST DIALYSIS

Facility Address:
913 E PINECREST DRIVE
MARSHALL, TX
ZIP 75670
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Facility Phone Number: 903 934-9660

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1366406506

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D1034970
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	PINECREST DIALYSIS
Street	913 E PINECREST DRIVE
City	MARSHALL
State	TX
ZIP	75670
Phone	903 934-9660
CertificateType	4
CertificateEffectiveDate	1/5/2023
CertificateExpirationDate	1/4/2025
FacilityType	Waiver

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