Provider Demographics
NPI:1013029933
Name:RENAL THERAPIES LLC
Entity Type:Organization
Organization Name:RENAL THERAPIES LLC
Other - Org Name:SHELBYVILLE COMMUNITY DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-698-1800
Mailing Address - Street 1:800 ROOSEVELT RD
Mailing Address - Street 2:STE E320
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5839
Mailing Address - Country:US
Mailing Address - Phone:630-942-1111
Mailing Address - Fax:630-942-1112
Practice Address - Street 1:410 S. HEINLEIN DR.
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565
Practice Address - Country:US
Practice Address - Phone:217-774-1527
Practice Address - Fax:217-774-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL142624261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
142624Medicare Oscar/Certification
IL=========001Medicaid