52D2011695 CLIA NUMBER - BAY SHORE DIALYSIS

Laboratory Demographics

  • CLIA Code: 52D2011695
  • Facility Name: BAY SHORE DIALYSIS
  • Facility Address: 5650 NORTH GREEN BAY AVE SUITE 150
    GLENDALE, WI
    ZIP 53209
  • Facility Phone: 414 431-5960
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: DR. MATTHEW H. HANNA
  • NPI Number: 1235457508
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 52D2011695
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name BAY SHORE DIALYSIS
Street 5650 NORTH GREEN BAY AVE SUITE 150
City GLENDALE
State WI
ZIP 53209
Phone 414 431-5960
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/20/2024
Certificate Expiration Date 8/19/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director DR. MATTHEW H. HANNA

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This page was last updated on: 9/29/2025