45D2034643 CLIA NUMBER - ODESSA DIALYSIS

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Laboratory Demographics

CLIA Number: 45D2034643

Facility Name: ODESSA DIALYSIS

Facility Address:
1216 E 8TH ST
ODESSA, TX
ZIP 79761
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Facility Phone Number: 432 888-9801

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1396183141

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2034643
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	ODESSA DIALYSIS
Street	1216 E 8TH ST
City	ODESSA
State	TX
ZIP	79761
Phone	432 888-9801
CertificateType	4
CertificateEffectiveDate	12/30/2023
CertificateExpirationDate	12/29/2025
FacilityType	Waiver

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