Organization
ISD BRANDON LLC
Active
Other names
Brandon Renal 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
101 CHRISTIAN DR, BRANDON, MS 39042-2678
(601) 824-9764
(601) 824-9761
Mailing address
5200 VIRGINIA WAY, 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
—
00220416
—
MS
Enumeration date
06/02/2006
Last updated
12/01/2025
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