Organization
ISD RENAL INC
Active
Other names
Jackson Southwest 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
1828 RAYMOND RD, JACKSON, MS 39204-4126
(601) 373-7897
(601) 373-7899
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
—
00220062
—
MS
Enumeration date
05/24/2006
Last updated
11/19/2024
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