Organization
RENAL TREATMENT CENTERS-ILLINOIS INC
Active
Other names
Eden Prairie 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
14852 SCENIC HEIGHTS RD STE 255, BLDG B, EDEN PRAIRIE, MN 55344-2320
(952) 934-2411
(952) 934-3851
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
—
488935500
—
MN
Enumeration date
04/13/2006
Last updated
09/15/2025
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