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NPI Code Detail

MEDICARE: RENAL TREATMENT CENTERS-SOUTHEAST, LP.

MEDICARE: RENAL TREATMENT CENTERS-SOUTHEAST, LP.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center089LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104885243
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENAL TREATMENT CENTERS-SOUTHEAST, LP.
Provider Business Mailing Address
First Line : 5200 VIRGINIA WAY
Second Line : L&C DEPT
City : BRENTWOOD
State : TN
Zip : 37027-7569
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2108 AVENUE F
Second Line :
City : BOGALUSA
State : LA
Zip : 70427-5027
Country : US
Telephone Number : 985-735-7811
Fax Number : 985-735-1501
Authorized Official
Title or Position : VP, LICENSURE & CERTIFICATION
Name : SAMUEL T WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 03/18/2006
Last Update Date : 10/02/2025

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