Organization
ISD RENAL INC
Active
Other names
Lehigh Avenue 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
1300 W LEHIGH AVE, STE 106, PHILADELPHIA, PA 19132-2764
(215) 223-1018
(215) 223-1019
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
—
102029010
—
PA
Enumeration date
07/24/2020
Last updated
11/19/2024
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