45D1079280 CLIA NUMBER - USRC WEST FORT WORTH DIALYSIS, LLC DBA US RENAL CARE WEST FORT WORTH DIALYSIS

Laboratory Demographics

CLIA Number: 45D1079280

Facility Name: USRC WEST FORT WORTH DIALYSIS, LLC DBA US RENAL CARE WEST FORT WORTH DIALYSIS

Facility Address:
1704 S CHERRY LN SUITE 200
WHITE SETTLEMENT, TX
ZIP 76108
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Facility Phone Number: 817 367-0822

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1407030364

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D1079280
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	USRC WEST FORT WORTH DIALYSIS, LLC DBA US RENAL CARE WEST FORT WORTH DIALYSIS
Street	1704 S CHERRY LN SUITE 200
City	WHITE SETTLEMENT
State	TX
ZIP	76108
Phone	817 367-0822
CertificateType	4
CertificateEffectiveDate	1/29/2024
CertificateExpirationDate	1/28/2026
FacilityType	Waiver

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