Organization
ISD RENAL INC
Active
Other names
Girard Estates Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1930 S BROAD ST UNIT 7, PHILADELPHIA, PA 19145-2328
(215) 463-3120
(215) 463-3107
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
—
1020290100012
—
PA
Enumeration date
07/24/2020
Last updated
09/17/2025
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