52D0957895 CLIA NUMBER - CEDARBURG DIALYSIS

Laboratory Demographics

CLIA Number: 52D0957895

Facility Name: CEDARBURG DIALYSIS

Facility Address:
N54 W6135 MILL ST
CEDARBURG, WI
ZIP 53012
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Facility Phone Number: 262 376-8011

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1811951627

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	52D0957895
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	CEDARBURG DIALYSIS
Street	N54 W6135 MILL ST
City	CEDARBURG
State	WI
ZIP	53012
Phone	262 376-8011
CertificateType	4
CertificateEffectiveDate	3/5/2023
CertificateExpirationDate	3/4/2025
FacilityType	Waiver

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