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NPI Code Detail

MEDICARE: ISD RENAL INC

MEDICARE: ISD 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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number : 1659233492
Entity Type Code : Organization
Provider Name (Legal Business Name) : ISD RENAL INC
Provider Business Mailing Address
First Line : 5200 VIRGINIA WAY
Second Line : ATTN L&C
City : BRENTWOOD
State : TN
Zip : 37027-7569
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2980 POPLAR AVE STE 102
Second Line :
City : MEMPHIS
State : TN
Zip : 38111-3531
Country : US
Telephone Number : 860-690-2856
Fax Number :
Authorized Official
Title or Position : VP, LICENSURE & CERTIFICATION
Name : SAMUEL T WEY
Credential :
Telephone Number : 615-341-6691
Provider Enumeration Date : 12/01/2025
Last Update Date : 12/01/2025

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Directions to “ISD RENAL INC ” Practice Location

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