52D1089847 CLIA NUMBER - TRI STATE DIALYSIS

Laboratory Demographics

CLIA Number: 52D1089847

Facility Name: TRI STATE DIALYSIS

Facility Address:
1250 E BUSINESS HIGHWAY 151, STE B PO BOX 511
PLATTEVILLE, WI
ZIP 53818
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Facility Phone Number: 608 348-5064

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1669426177

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	52D1089847
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	TRI STATE DIALYSIS
Street	1250 E BUSINESS HIGHWAY 151, STE B PO BOX 511
City	PLATTEVILLE
State	WI
ZIP	53818
Phone	608 348-5064
CertificateType	4
CertificateEffectiveDate	9/29/2022
CertificateExpirationDate	9/28/2024
FacilityType	Waiver

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