52D1076389 CLIA NUMBER - OAK CREEK DIALYSIS

Laboratory Demographics

CLIA Number: 52D1076389

Facility Name: OAK CREEK DIALYSIS

Facility Address:
8201 S HOWELL AVE STE 600
OAK CREEK, WI
ZIP 53154
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Facility Phone Number: 800 467-4736

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1851784599

Taxonomy: 261QD0000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	52D1076389
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	OAK CREEK DIALYSIS
Street	8201 S HOWELL AVE STE 600
City	OAK CREEK
State	WI
ZIP	53154
Phone	800 467-4736
CertificateType	4
CertificateEffectiveDate	11/13/2023
CertificateExpirationDate	11/12/2025
FacilityType	Waiver

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