44D1010242 CLIA NUMBER - ISD RENAL INC DBA WHITEHAVEN RENAL CENTER

Laboratory Demographics

  • CLIA Code: 44D1010242
  • Facility Name: ISD RENAL INC DBA WHITEHAVEN RENAL CENTER
  • Facility Address: 3420 ELVIS PRESLEY BLVD
    MEMPHIS, TN
    ZIP 38116
  • Facility Phone: 901 396-3794
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MASHUD MIRZA
  • NPI Number: 1457307936
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 44D1010242
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name ISD RENAL INC DBA WHITEHAVEN RENAL CENTER
Street 3420 ELVIS PRESLEY BLVD
City MEMPHIS
State TN
ZIP 38116
Phone 901 396-3794
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/10/2025
Certificate Expiration Date 3/9/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MASHUD MIRZA

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