14D1021243 CLIA NUMBER - JERSEYVILLE DIALYSIS TOTAL RENAL CARE INC

Laboratory Demographics

  • CLIA Code: 14D1021243
  • Facility Name: JERSEYVILLE DIALYSIS TOTAL RENAL CARE INC
  • Facility Address: 917 S STATE ST
    JERSEYVILLE, IL
    ZIP 62052
  • Facility Phone: 618 498-9532
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MEHER S. MALLICK
  • NPI Number: 1558666107
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D1021243
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name JERSEYVILLE DIALYSIS TOTAL RENAL CARE INC
Street 917 S STATE ST
City JERSEYVILLE
State IL
ZIP 62052
Phone 618 498-9532
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/16/2024
Certificate Expiration Date 1/15/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MEHER S. MALLICK

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