14D2122629 CLIA NUMBER - O'FALLON DIALYSIS

Laboratory Demographics

  • CLIA Code: 14D2122629
  • Facility Name: O'FALLON DIALYSIS
  • Facility Address: 1941 FRANK SCOTT PKWY, STE A
    SHILOH, IL
    ZIP 62269
  • Facility Phone: 618 622-0592
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: BASSIM ASSIOUN
  • NPI Number: 1487105649
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2122629
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name O'FALLON DIALYSIS
Street 1941 FRANK SCOTT PKWY, STE A
City SHILOH
State IL
ZIP 62269
Phone 618 622-0592
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/1/2024
Certificate Expiration Date 11/30/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director BASSIM ASSIOUN

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