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General NPI Number Information
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NPI Number | 1174579619
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Entity Type | Organization
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Legal Business Name | ISD RENAL INC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 11/05/2025
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Provider Practice Location Address
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Address Line | 1635 MINERAL SPRING AVE
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-4025
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Country | US
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Telephone | 401-354-5340
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Fax | 401-353-7020
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Provider Business Mailing Address
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Address Line | 5200 VIRGINIA WAY L & C DEPT
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City | BRENTWOOD
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State | TN
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Zip | 37027-7569
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP, LICENSURE & CERTIFICATION
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Name | SAMUEL T WEY
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Credential |
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Telephone | 615-341-6641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | KDT00741
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License Number State | RI
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