Organization
RENAL TREATMENT CENTERS-ILLINOIS INC.
Active
Other names
Eastgate 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
4435 AICHOLTZ RD, STE 800A, CINCINNATI, OH 45245-1690
(513) 752-5544
(513) 752-5736
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
0241DC
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0868799
—
OH
Enumeration date
04/13/2006
Last updated
02/17/2025
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