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General NPI Number Information
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NPI Number | 1316540388
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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 | 11/20/2020
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 8001 LANSDOWNE AVE
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City | UPPER DARBY
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State | PA
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Zip | 19082-5407
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Country | US
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Telephone | 484-603-3054
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Fax | 484-603-3074
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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 |
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License Number State |
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