49D0225066 CLIA NUMBER - TAPPAHANNOCK DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 49D0225066

Facility Name: TAPPAHANNOCK DIALYSIS CENTER

Facility Address:
1922 TAPPAHANNOCK BOULEVARD
TAPPAHANNOCK, VA
ZIP 22560
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Facility Phone Number: 804 443-6542

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1952406241

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	49D0225066
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	TAPPAHANNOCK DIALYSIS CENTER
Street	1922 TAPPAHANNOCK BOULEVARD
City	TAPPAHANNOCK
State	VA
ZIP	22560
Phone	804 443-6542
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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