Provider Demographics
NPI:1639242506
Name:RENAL INTERVENTION CENTER, PLLC
Entity type:Organization
Organization Name:RENAL INTERVENTION CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:B
Authorized Official - Last Name:SADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-676-8123
Mailing Address - Street 1:430 MAXINE DR
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2495
Mailing Address - Country:US
Mailing Address - Phone:309-266-7600
Mailing Address - Fax:309-676-8455
Practice Address - Street 1:430 MAXINE DR
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2495
Practice Address - Country:US
Practice Address - Phone:309-495-5420
Practice Address - Fax:309-495-5410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7002728261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid