45D2092102 CLIA NUMBER - INNOVATIVE DIALYSIS CENTER OF LUBBOCK,LLC DBA US RENAL CARE NORTH LUBBOCK DIALYSIS

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Laboratory Demographics

CLIA Number: 45D2092102

Facility Name: INNOVATIVE DIALYSIS CENTER OF LUBBOCK,LLC DBA US RENAL CARE NORTH LUBBOCK DIALYSIS

Facility Address:
1826 PARKWAY DRIVE SUITE 200
LUBBOCK, TX
ZIP 79403
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Facility Phone Number: 806 747-1366

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1013306133

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2092102
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	INNOVATIVE DIALYSIS CENTER OF LUBBOCK,LLC DBA US RENAL CARE NORTH LUBBOCK DIALYSIS
Street	1826 PARKWAY DRIVE SUITE 200
City	LUBBOCK
State	TX
ZIP	79403
Phone	806 747-1366
CertificateType	4
CertificateEffectiveDate	2/26/2023
CertificateExpirationDate	2/25/2025
FacilityType	Waiver

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