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NPI Code Detail

MEDICARE: RENALCARE ASSOCIATES, S.C.

MEDICARE: RENALCARE ASSOCIATES, S.C.
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
1363L00000XNurse Practitioner
2208600000XSurgery Physician042003556IL
3363A00000XPhysician Assistant
4207RN0300XNephrology Physician042003556IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CA301OTHERILRAILROAD MEDICARE

General Provider Information

NPI Number : 1649300377
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENALCARE ASSOCIATES, S.C.
Provider Business Mailing Address
First Line : 420 NE GLEN OAK AVE STE 401
Second Line :
City : PEORIA
State : IL
Zip : 61603-3112
Country : US
Telephone Number : 309-676-8123
Fax Number : 309-676-8455
Provider Business Practice Location Address
First Line : 420 NE GLEN OAK AVE STE 401
Second Line :
City : PEORIA
State : IL
Zip : 61603-3112
Country : US
Telephone Number : 309-676-8123
Fax Number : 309-676-8455
Authorized Official
Title or Position : ADMINISTRATIVE ASSISTANT
Name : STEPHANIE EYMAN
Credential :
Telephone Number : 309-624-9259
Provider Enumeration Date : 03/06/2007
Last Update Date : 02/12/2026

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