Organization
ISD RENAL INC
Active
Other names
Fairmount Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
1236 N 26TH ST, PHILADELPHIA, PA 19121-4602
(215) 763-3974
(215) 765-1494
Mailing address
5200 VIRGINIA WAY, L & C DEPT, BRENTWOOD, TN 37027-7569
(615) 341-6410
(888) 662-8259
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
—
102029010
—
PA
Enumeration date
06/30/2017
Last updated
08/07/2020
Update your record
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