MEDICARE: RAINER DIALYSIS LLC

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

Other Identifiers

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

General Provider Information

NPI Number	:	1245580570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAINER DIALYSIS LLC

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	:	615-341-6264
Fax Number	:	800-297-2925

Provider Business Practice Location Address
First Line	:	3740 S JEFFERSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-3905
Country	:	US
Telephone Number	:	314-664-6687
Fax Number	:	314-772-1614

Authorized Official
Title or Position	:	SR DIR LICENSURE & CERTIFICATION
Name	:	SAMUEL WEY
Credential	:
Telephone Number	:	615-341-6641

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	09/08/2023

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