MEDICARE: LINCOLN PARK DIALYSIS SERVICES 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	:	1659330694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINCOLN PARK DIALYSIS SERVICES INC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L&C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2484 N ELSTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2002
Country	:	US
Telephone Number	:	773-278-4403
Fax Number	:	773-489-6986

Authorized Official
Title or Position	:	VP, LICENSURE & CERTIFICATION
Name	:	SAMUEL T WEY
Credential	:
Telephone Number	:	615-341-6641

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	01/15/2025

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