Organization
RENAL TREATMENT CENTERS-ILLINOIS INC
Active
Other names
Hampton Avenue 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
1425 HAMPTON AVE, SAINT LOUIS, MO 63139-3115
(314) 781-4022
(314) 781-4063
Mailing address
5200 VIRGINIA WAY, L&C DEPT, 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
—
507403301
—
MO
05
—
=========
—
IL
Enumeration date
03/31/2006
Last updated
10/18/2024
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