DIALYSIS OF NORTHERN ILLINOIS LLC NPI 1003875402

NPI Information

  • NPI: 1003875402
  • Provider Name: DIALYSIS OF NORTHERN ILLINOIS LLC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • :
  • Address: 622 ROXBURY RD
    ROCKFORD, IL
    ZIP 61107
  • Phone: (815) 397-0713

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NPI Details

DIALYSIS OF NORTHERN ILLINOIS LLC is an end-stage renal disease (esrd) treatment clinic center in Rockford, IL. DIALYSIS OF NORTHERN ILLINOIS LLC NPI is 1003875402. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

622 ROXBURY RD
ROCKFORD, IL
ZIP 61107-089
Phone: (815) 397-0713
Fax: (815) 397-0796

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 enumeration date for this NPI number is 3/23/2006 and was last updated on 5/14/2025.

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
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentYes

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=========MEDICAIDILLINOIS

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: 3/30/2025

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