51D0967212 CLIA NUMBER - WEST VIRGINIA DIALYSIS DAVITA INC

Laboratory Demographics

  • CLIA Code: 51D0967212
  • Facility Name: WEST VIRGINIA DIALYSIS DAVITA INC
  • Facility Address: 300 PROSPERITY LANE SUITE 150
    LOGAN, WV
    ZIP 25601
  • Facility Phone: 304 752-2700
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: AHMAD B. FARIDI MD
  • NPI Number: 1831154442
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 51D0967212
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name WEST VIRGINIA DIALYSIS DAVITA INC
Street 300 PROSPERITY LANE SUITE 150
City LOGAN
State WV
ZIP 25601
Phone 304 752-2700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/28/2025
Certificate Expiration Date 3/27/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director AHMAD B. FARIDI MD

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