Organization
RENAL TREATMENT CENTERS-ILLINOIS INC
Active
Other names
Davison 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
1011 S STATE RD, DAVISON, MI 48423-1903
(810) 658-8224
(810) 658-8232
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
—
1609837103
—
MI
Enumeration date
04/01/2006
Last updated
11/13/2024
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