Organization
RENAL TREATMENT CENTERS-ILLINOIS INC
Active
Organization
RENAL TREATMENT CENTERS-ILLINOIS INC
Active
Other names
Owensboro 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
1930 E PARRISH AVE, OWENSBORO, KY 42303-1443
(270) 926-0120
(270) 691-9865
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPARTMENT, BRENTWOOD, TN 37027
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
300129
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39000674
—
KY
01
—
=========
TRICARE
KY
Enumeration date
03/27/2006
Last updated
04/16/2024
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