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General NPI Number Information
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NPI Number | 1639242506
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Entity Type | Organization
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Legal Business Name | RENAL INTERVENTION CENTER, PLLC
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 430 MAXINE DR
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City | MORTON
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State | IL
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Zip | 61550-2495
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Country | US
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Telephone | 309-266-7600
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Fax | 309-266-7680
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Provider Business Mailing Address
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Address Line | 430 MAXINE DR
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City | MORTON
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State | IL
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Zip | 61550-2495
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Country | US
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Telephone | 309-266-7600
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Fax | 309-676-8455
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SAMER B SADER
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Credential | MD
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Telephone | 309-676-8123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 7002728
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License Number State | IL
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