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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center		GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801285507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISD RENAL INC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	LICENSURE AND CERTIFICATION DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-320-4268
Fax Number	:	877-238-0567

Provider Business Practice Location Address
First Line	:	4880 LOWER ROSWELL RD
Second Line	:	SUITE 770
City	:	MARIETTA
State	:	GA
Zip	:	30068-4375
Country	:	US
Telephone Number	:	770-321-0675
Fax Number	:	770-509-8283

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER
Name	:	JOHN WINSTEL
Credential	:
Telephone Number	:	253-733-4501

Provider Enumeration Date	:	01/19/2015
Last Update Date	:	05/24/2022

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Directions to “ISD RENAL INC ” Practice Location

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