Organization
RENAL TREATMENT CENTERS-ILLINOIS INC.
Active
Other names
Park Plaza 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
G1075 N BALLENGER HWY, FLINT, MI 48504-4431
(810) 235-8468
(810) 235-9144
Mailing address
5200 VIRGINIA WAY, ATT: 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
—
4620087
—
MI
Enumeration date
04/04/2006
Last updated
06/18/2024
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