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General NPI Number Information
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NPI Number | 1730149170
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Entity Type | Organization
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Legal Business Name | RENAL TREATMENT CENTERS-ILLINOIS INC
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 04/16/2024
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Provider Practice Location Address
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Address Line | 1930 E PARRISH AVE
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City | OWENSBORO
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State | KY
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Zip | 42303-1443
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Country | US
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Telephone | 270-926-0120
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Fax | 270-691-9865
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Provider Business Mailing Address
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Address Line | 5200 VIRGINIA WAY ATT: L&C DEPARTMENT
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City | BRENTWOOD
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State | TN
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Zip | 37027
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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 | 300129
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License Number State | KY
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