Organization
RENAL TREATMENT CENTERS - ILLINOIS INC
Active
Other names
Fowlerville Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS O USILTON JR. (GROUP VICE PRESIDENT)
(770) 541-7922
Entity
Organization
Contact information
Practice address
206 E GRAND AVE, FOWLERVILLE, MI 48836-0128
(517) 223-0770
(517) 223-0208
Mailing address
5200 VIRGINIA WAY, STE 400 L&C, BRENTWOOD, TN 37027-7569
(615) 320-4218
(303) 209-7821
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
—
4511206
—
MI
Enumeration date
04/05/2006
Last updated
07/17/2009
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