Organization
RENAL TREATMENT CENTERS-ILLINOIS INC.
Active
Other names
Black Hawk 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
3421 W 9TH ST, WATERLOO, IA 50702-5401
(319) 272-8700
(319) 272-8695
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
—
1184868267
—
IA
Enumeration date
04/21/2009
Last updated
02/09/2026
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