Healthcare Provider Details

I. General information

NPI: 1063477982
Provider Name (Legal Business Name): RENAL LIFE LINK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 MOUNT SAINT MARYS DR
NELSONVILLE OH
45764-1280
US

IV. Provider business mailing address

5200 VIRGINIA WAY STE. 400 L&C
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 740-753-2398
  • Fax: 740-753-2495
Mailing address:
  • Phone: 615-320-4435
  • Fax: 303-209-7821

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: THOMAS O USILTON JR.
Title or Position: GROUP VICE PRESIDENT
Credential:
Phone: 770-541-7922