MEDICARE: RENAL TREATMENT CENTERS CALIFORNIA INC.

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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1174201404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAL TREATMENT CENTERS CALIFORNIA INC.

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	ATTN: L&C DEPARTMENT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-341-6282
Fax Number	:	866-510-6389

Provider Business Practice Location Address
First Line	:	4670 CENTRAL WAY STE D
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-1806
Country	:	US
Telephone Number	:	615-341-6282
Fax Number	:

Authorized Official
Title or Position	:	VP LICENSE & CERTIFICATION
Name	:	SAM T WEY
Credential	:
Telephone Number	:	615-341-6691

Provider Enumeration Date	:	07/07/2023
Last Update Date	:	06/10/2024

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