45D1091762 CLIA NUMBER - LIBERTY DIALYSIS BRYAN

Laboratory Demographics

  • CLIA Code: 45D1091762
  • Facility Name: LIBERTY DIALYSIS BRYAN
  • Facility Address: 2390 E 29TH ST
    BRYAN, TX
    ZIP 77802
  • Facility Phone: 979 314-1550
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: KOURTNEY L. HALLMARK
  • NPI Number: 1396929998
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D1091762
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LIBERTY DIALYSIS BRYAN
Street 2390 E 29TH ST
City BRYAN
State TX
ZIP 77802
Phone 979 314-1550
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/10/2024
Certificate Expiration Date 11/9/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director KOURTNEY L. HALLMARK

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This page was last updated on: 9/29/2025