52D0391433 CLIA NUMBER - LOOMIS ROAD DIALYSIS

Laboratory Demographics

  • CLIA Code: 52D0391433
  • Facility Name: LOOMIS ROAD DIALYSIS
  • Facility Address: 4120 W LOOMIS RD
    GREENFIELD, WI
    ZIP 53221
  • Facility Phone: 414 761-4920
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. AJJAMPUR R. VIDYARANYA
  • NPI Number: 1720042559
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D0391433
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LOOMIS ROAD DIALYSIS
Street 4120 W LOOMIS RD
City GREENFIELD
State WI
ZIP 53221
Phone 414 761-4920
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. AJJAMPUR R. VIDYARANYA

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This page was last updated on: 3/20/2025