Organization · Type 2 NPI

Renal Treatment Centers Northeast Inc

End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Philadelphia, PA

NPI number 1104095041 Active

Practice location

1172 S Broad St
Philadelphia, PA 19146-3142

Call (215) 875-6720 Map

Fax (215) 875-6721

Mailing address

5200 Virginia Way, L&c Dept
Brentwood, TN 37027-7569

Specialties and licenses

Taxonomy	Code	License
End-Stage Renal Disease (ESRD) Treatment Clinic/Center Primary	261QE0700X	None listed

End-Stage Renal Disease (ESRD) Treatment Clinic/Center: Definition to come...

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NPI record

NPI: 1104095041
Entity type: Organization (Type 2)
Issued: Feb 25, 2008
Last updated: Jan 6, 2025
Status: Active

Other names

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South Broad Street Dialysis · doing business as
South Broad Street Dialysis · doing business as

Authorized official

Samuel Wey
VP, Licensure & Certification
(615) 341-6641

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About NPI 1104095041

Renal Treatment Centers Northeast Inc's National Provider Identifier is 1104095041, issued on Feb 25, 2008. The primary taxonomy on file is End-Stage Renal Disease (ESRD) Treatment Clinic/Center (261QE0700X), and the practice location is in Philadelphia, PA. The record was last updated on Jan 6, 2025.