45D1090088 CLIA NUMBER - FRESENIUS MEDICAL CARE DESERT MILAGRO DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 45D1090088

Facility Name: FRESENIUS MEDICAL CARE DESERT MILAGRO DIALYSIS CENTER

Facility Address:
230 NORTH WASHINGTON AVENUE
ODESSA, TX
ZIP 79761
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Facility Phone Number: 432 332-3058

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1871884163

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D1090088
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FRESENIUS MEDICAL CARE DESERT MILAGRO DIALYSIS CENTER
Street	230 NORTH WASHINGTON AVENUE
City	ODESSA
State	TX
ZIP	79761
Phone	432 332-3058
CertificateType	4
CertificateEffectiveDate	10/2/2022
CertificateExpirationDate	10/1/2024
FacilityType	Waiver

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