46D1079045 CLIA NUMBER - LIBERTY DIALYSIS-ST GEORGE LLC

Laboratory Demographics

CLIA Number: 46D1079045

Facility Name: LIBERTY DIALYSIS-ST GEORGE LLC

Facility Address:
624 S 1000 E STE 101
ST GEORGE, UT
ZIP 84790
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Facility Phone Number: 801 747-0880

Facility Type: Blood Bank

Certificate Type: Waiver

NPI Number: 1861671422

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	46D1079045
LAB Type	Blood Bank
Facility Name	LIBERTY DIALYSIS-ST GEORGE LLC
Street	624 S 1000 E STE 101
City	ST GEORGE
State	UT
ZIP	84790
Phone	801 747-0880
CertificateType	4
CertificateEffectiveDate	1/24/2024
CertificateExpirationDate	1/23/2026
FacilityType	Waiver

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