14D2151548 CLIA NUMBER - EDGEMONT DIALYSIS

Laboratory Demographics

  • CLIA Code: 14D2151548
  • Facility Name: EDGEMONT DIALYSIS
  • Facility Address: 8 VIEUX CARRE DR
    E ST LOUIS, IL
    ZIP 62203
  • Facility Phone: 618 398-3809
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: FELICIA R. BENTLEY M D
  • NPI Number: 1801386586
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2151548
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name EDGEMONT DIALYSIS
Street 8 VIEUX CARRE DR
City E ST LOUIS
State IL
ZIP 62203
Phone 618 398-3809
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/20/2024
Certificate Expiration Date 7/19/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director FELICIA R. BENTLEY M D

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