49D0902695 CLIA NUMBER - TYSONS CORNER DIALYSIS

Laboratory Demographics

CLIA Number: 49D0902695

Facility Name: TYSONS CORNER DIALYSIS

Facility Address:
8391 OLD COURTHOUSE ROAD - SUITE 160
VIENNA, VA
ZIP 22182
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Facility Phone Number: 703 824-8644

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1356528327

Taxonomy: 1223G0001X - Dentist
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

CLIA Record

Field Name	Field Value
CLIA Number	49D0902695
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	TYSONS CORNER DIALYSIS
Street	8391 OLD COURTHOUSE ROAD - SUITE 160
City	VIENNA
State	VA
ZIP	22182
Phone	703 824-8644
CertificateType	4
CertificateEffectiveDate	6/27/2023
CertificateExpirationDate	6/26/2025
FacilityType	Waiver

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