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NPI Code Detail

MEDICARE: RENAL TREATMENT CENTERS-ILLINOIS INC

MEDICARE: RENAL TREATMENT CENTERS-ILLINOIS INC
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/Center0463DCOH

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 : 1477517571
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENAL TREATMENT CENTERS-ILLINOIS INC
Provider Business Mailing Address
First Line : 5200 VIRGINIA WAY
Second Line : ATT: L&C DEPARTMENT
City : BRENTWOOD
State : TN
Zip : 37027-7569
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 215 S ALLISON AVE
Second Line :
City : XENIA
State : OH
Zip : 45385-3694
Country : US
Telephone Number : 937-376-1453
Fax Number : 937-374-2930
Authorized Official
Title or Position : VP LICENSURE & CERTIFICATION
Name : SAMUEL T WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 04/14/2006
Last Update Date : 07/11/2024

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Directions to “RENAL TREATMENT CENTERS-ILLINOIS INC ” Practice Location

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