14D2135472 CLIA NUMBER - PARK MANOR DIALYSIS

Laboratory Demographics

  • CLIA Code: 14D2135472
  • Facility Name: PARK MANOR DIALYSIS
  • Facility Address: 9505 S COLFAX AVE
    CHICAGO, IL
    ZIP 60617
  • Facility Phone: 773 978-5237
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: RITA L. MC GILL MD
  • NPI Number: 1548791163
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2135472
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name PARK MANOR DIALYSIS
Street 9505 S COLFAX AVE
City CHICAGO
State IL
ZIP 60617
Phone 773 978-5237
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/22/2025
Certificate Expiration Date 8/21/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director RITA L. MC GILL MD

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