Organization
RENAL TREATMENT CENTERS-ILLINOIS INC.
Active
Other names
Jackson 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
234 W LOUIS GLICK HWY, JACKSON, MI 49201-1326
(517) 841-1712
(517) 841-1724
Mailing address
5200 VIRGINIA WAY, ATT: 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
—
1952362469
—
MI
Enumeration date
05/08/2015
Last updated
06/04/2024
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