Organization
RENAL TREATMENT CENTERS-ILLINOIS INC.
Active
Other names
St Louis Park Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
3505 LOUISIANA AVE S, ST LOUIS PARK, MN 55426-4121
(952) 285-1400
(952) 285-1406
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
—
564120900
—
MN
Enumeration date
04/13/2006
Last updated
05/23/2024
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