Organization
ISD RENAL INC
Active
Other names
Brown Street 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
4800 BROWN ST, STE 201, PHILADELPHIA, PA 19139-2105
(215) 581-4993
(215) 883-1573
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
07/25/2024
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