49D0884608 CLIA NUMBER - RUSSELL COUNTY DIALYSIS FACILITY

Laboratory Demographics

  • CLIA Code: 49D0884608
  • Facility Name: RUSSELL COUNTY DIALYSIS FACILITY
  • Facility Address: 150 EAST MAIN STREET
    LEBANON, VA
    ZIP 24266
  • Facility Phone: 276 889-1712
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SHAWNA RIFE
  • NPI Number: 1255435020
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 49D0884608
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name RUSSELL COUNTY DIALYSIS FACILITY
Street 150 EAST MAIN STREET
City LEBANON
State VA
ZIP 24266
Phone 276 889-1712
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2024
Certificate Expiration Date 4/5/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SHAWNA RIFE

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This page was last updated on: 6/4/2025