Provider Demographics
NPI:1760438329
Name:DSI RENAL INC
Entity Type:Organization
Organization Name:DSI RENAL INC
Other - Org Name:NRI PROVIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TYRONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FEATHERSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-1165
Mailing Address - Street 1:511 UNION ST
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-1733
Mailing Address - Country:US
Mailing Address - Phone:615-234-1165
Mailing Address - Fax:615-234-2494
Practice Address - Street 1:40 HEMINGWAY DR
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915-2224
Practice Address - Country:US
Practice Address - Phone:401-438-5930
Practice Address - Fax:401-438-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
412500Medicare Oscar/Certification