52D2026503 CLIA NUMBER - WISCONSIN RAPIDS DIALYSIS

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Laboratory Demographics

CLIA Number: 52D2026503

Facility Name: WISCONSIN RAPIDS DIALYSIS

Facility Address:
1041B HILL ST
WISCONSIN RAPIDS, WI
ZIP 54494
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Facility Phone Number: 715 422-0550

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1790075091

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	52D2026503
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	WISCONSIN RAPIDS DIALYSIS
Street	1041B HILL ST
City	WISCONSIN RAPIDS
State	WI
ZIP	54494
Phone	715 422-0550
CertificateType	4
CertificateEffectiveDate	7/1/2023
CertificateExpirationDate	6/30/2025
FacilityType	Waiver

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