14D2128312 CLIA NUMBER - COLLINSVILLE DIALYSIS

Laboratory Demographics

  • CLIA Code: 14D2128312
  • Facility Name: COLLINSVILLE DIALYSIS
  • Facility Address: 101 LANTER CT
    COLLINSVILLE, IL
    ZIP 62234
  • Facility Phone: 618 344-2016
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SRIRAJ KANUNGO MD
  • NPI Number: 1811437106
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2128312
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name COLLINSVILLE DIALYSIS
Street 101 LANTER CT
City COLLINSVILLE
State IL
ZIP 62234
Phone 618 344-2016
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/28/2025
Certificate Expiration Date 3/27/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SRIRAJ KANUNGO MD

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