45D1064622 CLIA NUMBER - WOODVILLE DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 45D1064622

Facility Name: WOODVILLE DIALYSIS CENTER

Facility Address:
712 W BLUFF ST PECAN PLAZA
WOODVILLE, TX
ZIP 75979
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Facility Phone Number: 409 331-1500

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1831288646

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D1064622
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WOODVILLE DIALYSIS CENTER
Street	712 W BLUFF ST PECAN PLAZA
City	WOODVILLE
State	TX
ZIP	75979
Phone	409 331-1500
CertificateType	4
CertificateEffectiveDate	2/9/2023
CertificateExpirationDate	2/8/2025
FacilityType	Waiver

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