Healthcare Provider Details

I. General information

NPI: 1639242506
Provider Name (Legal Business Name): RENAL INTERVENTION CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 MAXINE DR
MORTON IL
61550-2495
US

IV. Provider business mailing address

430 MAXINE DR
MORTON IL
61550-2495
US

V. Phone/Fax

Practice location:
  • Phone: 309-266-7600
  • Fax: 309-266-7680
Mailing address:
  • Phone: 309-266-7600
  • Fax: 309-676-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number7002728
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAMER SADER
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 309-676-8123