45D2168774 CLIA NUMBER - FRESENIUS KIDNEY CARE JASPER

Laboratory Demographics

CLIA Number: 45D2168774

Facility Name: FRESENIUS KIDNEY CARE JASPER

Facility Address:
2014 SOUTH WHEELER ST, SUITE 300
JASPER, TX
ZIP 75951
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Facility Phone Number: 409 384-2711

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1134780117

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	45D2168774
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	FRESENIUS KIDNEY CARE JASPER
Street	2014 SOUTH WHEELER ST, SUITE 300
City	JASPER
State	TX
ZIP	75951
Phone	409 384-2711
CertificateType	4
CertificateEffectiveDate	7/9/2023
CertificateExpirationDate	7/8/2025
FacilityType	Waiver

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