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NPI Code Detail

MEDICARE: DIALYSIS OF NORTHERN ILLINOIS LLC

MEDICARE: DIALYSIS OF NORTHERN ILLINOIS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003875402
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIALYSIS OF NORTHERN ILLINOIS LLC
Provider Business Mailing Address
First Line : 5200 VIRGINIA WAY
Second Line : ATT: L&C DEPT
City : BRENTWOOD
State : TN
Zip : 37027
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 622 ROXBURY RD
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-5089
Country : US
Telephone Number : 815-397-0713
Fax Number : 815-397-0796
Authorized Official
Title or Position : VP, LICENSURE & CERTIFICATION
Name : SAMUEL T WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 03/23/2006
Last Update Date : 04/08/2026

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Directions to “DIALYSIS OF NORTHERN ILLINOIS LLC ” Practice Location

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