RENAL INTERVENTION CENTER LLC NPI 1639242506

NPI Information

NPI: 1639242506
Provider Name: RENAL INTERVENTION CENTER, LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 14D1013189

Address:
430 MAXINE DR
MORTON, IL
ZIP 61550
Phone: (309) 495-5420
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RENAL INTERVENTION CENTER, LLC is an ambulatory surgical clinic center in Morton, IL. RENAL INTERVENTION CENTER, LLC NPI is 1639242506. The provider is registered as an organization entity type.

The provider's business location address is:

430 MAXINE DR
MORTON, IL
ZIP 61550-495
Phone: (309) 495-5420
Fax: (309) 495-5410

The provider's authorized official is Timothy A Pflederer .
The authorized official title is Medical Director and has the following contact phone number (309) 495-5420.

The CLIA number assigned to this NPI record is 14D1013189 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/16/2006 and was last updated on 8/22/2020.

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	261QA1903X	Clinic/Center	Ambulatory Surgical	7002728	ILLINOIS	Yes

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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