MEDICARE: DSI RENAL 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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1639124886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DSI RENAL INC

Provider Business Mailing Address
First Line	:	511 UNION ST
Second Line	:	SUITE 1800
City	:	NASHVILLE
State	:	TN
Zip	:	37219-1733
Country	:	US
Telephone Number	:	615-467-0134
Fax Number	:	615-234-2422

Provider Business Practice Location Address
First Line	:	2414 LAKE AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5406
Country	:	US
Telephone Number	:	260-420-7666
Fax Number	:	260-424-2036

Authorized Official
Title or Position	:	VP OF REIMBURSEMENT
Name	:	MRS. GRETCHEN K BARR
Credential	:
Telephone Number	:	615-467-0134

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	02/06/2008

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