14D2061469 CLIA NUMBER - RED BUD DIALYSIS (DBA) TOTAL RENAL CARE INC

Laboratory Demographics

  • CLIA Code: 14D2061469
  • Facility Name: RED BUD DIALYSIS (DBA) TOTAL RENAL CARE INC
  • Facility Address: 1500 E MARKET ST, LOT 4
    RED BUD, IL
    ZIP 62278
  • Facility Phone: 618 282-3444
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MEHER S. MALLICK
  • NPI Number: 1942647995
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2061469
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name RED BUD DIALYSIS (DBA) TOTAL RENAL CARE INC
Street 1500 E MARKET ST, LOT 4
City RED BUD
State IL
ZIP 62278
Phone 618 282-3444
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/28/2025
Certificate Expiration Date 6/27/2027
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