Healthcare Provider Details

I. General information

NPI: 1508243882
Provider Name (Legal Business Name): RENAL TREATMENT CENTERS-ILLINOIS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 DIXIE HWY STE 205
CLARKSTON MI
48346-2089
US

IV. Provider business mailing address

5200 VIRGINIA WAY
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 248-620-0958
  • Fax: 248-620-1204
Mailing address:
  • Phone: 615-320-4514
  • Fax: 866-594-9961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN D WINSTEL
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 253-733-4501