Organization
ISD RENAL INC
Active
Other names
Quad Counties Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
528 N GRANDSTAFF DR, AUBURN, IN 46706-1660
(260) 927-0100
(260) 927-1196
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4514
(866) 594-9961
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200827250F
—
IN
Enumeration date
05/25/2006
Last updated
12/02/2023
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