MEDICARE: ISD SUMMIT RENAL CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205882685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISD SUMMIT RENAL CARE LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	ATT: L&C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-238-3051
Fax Number	:	800-246-8346

Provider Business Practice Location Address
First Line	:	265 N MAIN ST
Second Line	:
City	:	MUNROE FALLS
State	:	OH
Zip	:	44262-1090
Country	:	US
Telephone Number	:	330-689-1400
Fax Number	:	330-689-1408

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER
Name	:	JOHN D WINSTEL
Credential	:
Telephone Number	:	253-733-4501

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	05/26/2023

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Directions to “ISD SUMMIT RENAL CARE LLC ” Practice Location

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