Organization
ISD RENAL INC
Active
Other names
Renal Care of Carthage
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
312 ELLIS ST, CARTHAGE, MS 39051
(601) 267-6856
(601) 267-6859
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4268
(877) 238-0567
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
—
00220635
—
MS
Enumeration date
05/24/2006
Last updated
03/08/2024
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