14D2235454 CLIA NUMBER - EDGEWATER DIALYSIS TOTAL RENAL CARE INC

Laboratory Demographics

  • CLIA Code: 14D2235454
  • Facility Name: EDGEWATER DIALYSIS TOTAL RENAL CARE INC
  • Facility Address: 615 HARRISON AVE
    ROCKFORD, IL
    ZIP 61104
  • Facility Phone: 610 336-8350
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: SYED MUSTAFA AHMED M D
  • NPI Number: 1154997591
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D2235454
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name EDGEWATER DIALYSIS TOTAL RENAL CARE INC
Street 615 HARRISON AVE
City ROCKFORD
State IL
ZIP 61104
Phone 610 336-8350
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/9/2025
Certificate Expiration Date 9/8/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director SYED MUSTAFA AHMED M D

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