Organization
RENAL TREATMENT CENTERS-ILLINOIS INC
Active
Other names
Maryville Home 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
2102 VADALABENE DR STE B, MARYVILLE, IL 62062-5632
(618) 288-1521
(618) 288-1759
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
Enumeration date
07/02/2007
Last updated
11/21/2024
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