14D2159969 CLIA NUMBER - NORTHGROVE DIALYSIS TOTAL RENAL CARE INC

Laboratory Demographics

  • CLIA Code: 14D2159969
  • Facility Name: NORTHGROVE DIALYSIS TOTAL RENAL CARE INC
  • Facility Address: 2491 INDUSTRIAL DR - STE 200
    HIGHLAND, IL
    ZIP 62249
  • Facility Phone: 618 651-1393
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SRIRAJ KANUNGO M D
  • NPI Number: 1063996858
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2159969
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name NORTHGROVE DIALYSIS TOTAL RENAL CARE INC
Street 2491 INDUSTRIAL DR - STE 200
City HIGHLAND
State IL
ZIP 62249
Phone 618 651-1393
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/2/2025
Certificate Expiration Date 1/1/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SRIRAJ KANUNGO M D

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