44D0956888 CLIA NUMBER - MEMPHIS KIDNEY/DIALYSIS SVC WHITEHAVEN

Laboratory Demographics

  • CLIA Code: 44D0956888
  • Facility Name: MEMPHIS KIDNEY/DIALYSIS SVC WHITEHAVEN
  • Facility Address: 4115 SOUTH PLAZA DRIVE
    MEMPHIS, TN
    ZIP 38116
  • Facility Phone: 901 398-6388
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: WESAM BALLOUK MD
  • NPI Number: 1487797536
  • Taxonomy: 2080A0000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 44D0956888
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name MEMPHIS KIDNEY/DIALYSIS SVC WHITEHAVEN
Street 4115 SOUTH PLAZA DRIVE
City MEMPHIS
State TN
ZIP 38116
Phone 901 398-6388
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/9/2025
Certificate Expiration Date 2/8/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director WESAM BALLOUK MD

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