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SOUTHEASTERN RENAL DIALYSIS L.C.
NPI 1609988617
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in Fort Madison, IA

Active since August 31, 2006CLIA 16D2341156 · Waiver
5/5
Overall Rating
4703 AVENUE L, FORT MADISON, IA 52627(319) 372-7996 Get Directions Write a Review

NPPES record last updated: March 16, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Southeastern Renal Dialysis L.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHEASTERN RENAL DIALYSIS L.C. (NPI 1609988617) is a healthcare organization registered as an end-stage renal disease (esrd) treatment in Fort Madison, Iowa and active in the NPI registry since August 2006. The organization holds a CLIA Waiver certificate valid through March 26, 2028 and lists Mary Liechty, Administrator, as its authorized official.

NPPES Registry Identity

NPI1609988617
Entity TypeOrganization
Primary Taxonomy261QE0700X
Legal Business NameSOUTHEASTERN RENAL DIALYSIS L.C.
Location Address4703 AVENUE LFort Madison, IA 52627-9505
Mailing Address507 S White StMt Pleasant, IA 52641-2625 · (319) 385-6564
Phone(319) 372-7996
Organization SubpartYes
Authorized OfficialMary LiechtyAdministrator · (319) 385-6728
Enumeration DateAugust 31, 2006
Last NPPES UpdateMarch 16, 2012
✔ NPI 1609988617 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · End-Stage Renal Disease (ESRD) TreatmentAmbulatory Health Care Facilities
Taxonomy Code261QE0700X
4703 AVENUE L, Fort Madison, IA 52627
Open in Google Maps ↗

Other Identifiers 1

Medicare OSCAR/certification162537IA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 16D2341156

Southeastern Renal Dialysis · Fort Madison, IA
Active · expires Mar 26, 2028
CLIA Number16D2341156
Laboratory TypeEnd Stage Renal Disease Dialysis Facility
Certificate Effective DateMarch 27, 2026
Certificate Expiration DateMarch 26, 2028
Laboratory DirectorKimberly M. Dewalt
Laboratory Phone(319) 372-7996
Laboratory LocationSoutheastern Renal Dialysis4703 Ave L, Fort Madison, IA 52627
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Dialysis Facility Quality Ratings CMS Care Compare

Quality ratings, services and patient survey results for Southeastern Renal Dialysis, L.C. - Mount Pleasant (CMS certification number 162509), from CMS Care Compare.

Southeastern Renal Dialysis, L.C. - Mount Pleasant

Dialysis facility · Mount Pleasant, IA
5/5 CMS RatingRating period January 2020 to December 2023
OwnershipProfit
CMS Certification Number162509
ESRD NetworkNetwork 12
Hemodialysis Stations12
Medicare-Certified SinceOctober 23, 1984
Location507 S White St Saunders ParkMount Pleasant, IA 52641 · Henry County
Phone(319) 385-6720
Services Offered
In-center hemodialysis Peritoneal dialysis Home hemodialysis training

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southeastern Renal Dialysis L.C.'s NPI number?

The NPI number for Southeastern Renal Dialysis L.C. is 1609988617. It was assigned to this organization in the NPPES registry on August 31, 2006.

Where is Southeastern Renal Dialysis L.C. located?

Southeastern Renal Dialysis L.C. is located at 4703 Avenue L, Fort Madison, IA 52627. The listed phone number is (319) 372-7996.

What is Southeastern Renal Dialysis L.C.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

Does Southeastern Renal Dialysis L.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 16D2341156) is associated with this NPI, valid through March 26, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is Southeastern Renal Dialysis L.C. a Medicare-certified dialysis facility?

Yes. Southeastern Renal Dialysis, L.C. - Mount Pleasant is a Medicare-certified dialysis facility, certified since October 23, 1984.

What quality rating does Southeastern Renal Dialysis L.C. have?

CMS rates Southeastern Renal Dialysis, L.C. - Mount Pleasant 5 out of 5 stars on Care Compare. The full measure detail is in the Dialysis Facility Quality section above.

When was this NPI record last updated?

The NPPES record for Southeastern Renal Dialysis L.C. was last updated on March 16, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.