Organization
ISD RENAL INC
Active
Other names
Rolla Home Training
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1702 E 10TH ST STE B, ROLLA, MO 65401-4868
(573) 458-2013
(573) 458-2094
Mailing address
5200 VIRGINIA WAY, L & C DEPARTMENT, BRENTWOOD, TN 37027-7569
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
—
500060490
—
MO
Enumeration date
10/20/2017
Last updated
03/04/2026
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