Organization
RENAL CENTER OF STORM LAKE, LLC
Active
Other names
Renal Center of Storm Lake
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T. WEY (VP, LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1426 LAKE AVE, STORM LAKE, IA 50588-1910
(712) 732-6900
(712) 732-6906
Mailing address
5200 VIRGINIA WAY, L & C DEPARTMENT, 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
—
0625186
—
IA
Enumeration date
05/28/2006
Last updated
06/10/2024
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