14D2104799 CLIA NUMBER - MACHESNEY PARK DIALYSIS

Laboratory Demographics

  • CLIA Code: 14D2104799
  • Facility Name: MACHESNEY PARK DIALYSIS
  • Facility Address: 7170 N PERRYVILLE RD
    MACHESNEY PARK, IL
    ZIP 61115
  • Facility Phone: 615 341-5819
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MICHAEL ROBERTSON
  • NPI Number: 1770957599
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2104799
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MACHESNEY PARK DIALYSIS
Street 7170 N PERRYVILLE RD
City MACHESNEY PARK
State IL
ZIP 61115
Phone 615 341-5819
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/12/2023
Certificate Expiration Date 11/11/2025
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MICHAEL ROBERTSON

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