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NPI Code Detail

MEDICARE: RENAL TREATMENT CENTERS-ILLINOIS INC

MEDICARE: RENAL TREATMENT CENTERS-ILLINOIS INC
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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number : 1538128533
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENAL TREATMENT CENTERS-ILLINOIS INC
Provider Business Mailing Address
First Line : 5200 VIRGINIA WAY
Second Line : L&C DEPT
City : BRENTWOOD
State : TN
Zip : 37027-7569
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4406 E LINCOLNWAY
Second Line :
City : STERLING
State : IL
Zip : 61081-9749
Country : US
Telephone Number : 815-535-0447
Fax Number : 815-535-9474
Authorized Official
Title or Position : VP LICENSURE & CERTIFICATION
Name : SAMUEL WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 03/20/2006
Last Update Date : 04/15/2024

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