50D1025935 CLIA NUMBER - UNION GAP DIALYSIS CENTER

Laboratory Demographics

CLIA Number: 50D1025935

Facility Name: UNION GAP DIALYSIS CENTER

Facility Address:
1236 AHTANUM RIDGE DR LOT 24
UNION GAP, WA
ZIP 98903
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Facility Phone Number: 509 469-6292

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1447214598

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	50D1025935
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	UNION GAP DIALYSIS CENTER
Street	1236 AHTANUM RIDGE DR LOT 24
City	UNION GAP
State	WA
ZIP	98903
Phone	509 469-6292
CertificateType	4
CertificateEffectiveDate	5/21/2004
CertificateExpirationDate	4/4/2028
FacilityType	Waiver

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