Organization
ISD RENAL INC
Active
Other names
Covington Trace 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
3999 HIGHWAY 190 EAST SERVICE RD STE A, COVINGTON, LA 70433-4914
(985) 276-1998
(985) 276-6856
Mailing address
5200 VIRGINIA WAY, 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
—
2489054
—
LA
Enumeration date
01/29/2018
Last updated
05/16/2024
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