45D2038071 CLIA NUMBER - BAINBRIDGE DIALYSIS, LLC D/B/A CENTRAL FORT WORTH DIALYSIS

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Laboratory Demographics

CLIA Number: 45D2038071

Facility Name: BAINBRIDGE DIALYSIS, LLC D/B/A CENTRAL FORT WORTH DIALYSIS

Facility Address:
1000 SAINT LOUIS AVE SUITE 101
FORT WORTH, TX
ZIP 76104
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Facility Phone Number: 817 810-0379

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1699041152

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2038071
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	BAINBRIDGE DIALYSIS, LLC D/B/A CENTRAL FORT WORTH DIALYSIS
Street	1000 SAINT LOUIS AVE SUITE 101
City	FORT WORTH
State	TX
ZIP	76104
Phone	817 810-0379
CertificateType	4
CertificateEffectiveDate	3/12/2024
CertificateExpirationDate	3/11/2026
FacilityType	Waiver

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