Organization
ISD RENAL INC
Active
Other names
Cornell Road 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
1700 NW 167TH PL STE 230, BEAVERTON, OR 97006-4872
(503) 439-8829
(503) 439-9942
Mailing address
5200 VIRGINIA WAY, ATTN: 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
—
500644442
—
OR
Enumeration date
05/03/2011
Last updated
07/22/2025
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