ISD RENAL INC NPI 1003390469

NPI Information

NPI: 1003390469
Provider Name: ISD RENAL INC

Doing Business As: FOREMAN DRIVE HOME TRAINING

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
1843 FOREMAN DR STE 201
COOKEVILLE, TN
ZIP 38501
Phone: (931) 372-2706
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ISD RENAL INC is an end-stage renal disease (esrd) treatment clinic center in Cookeville, TN. ISD RENAL INC NPI is 1003390469. The provider is registered as an organization entity type.
The provider Is Doing Business As Foreman Drive Home Training.

The provider's business location address is:

1843 FOREMAN DR STE 201
COOKEVILLE, TN
ZIP 38501-933
Phone: (931) 372-2706
Fax: (931) 372-8421

The provider's authorized official is Samuel T Wey .
The authorized official title is Vp Licensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 44D2155650 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/21/2018 and was last updated on 10/25/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	Q052745	MEDICAID	TENNESSEE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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