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NPI Code Detail

MEDICARE: WHEELING RENAL CARE LLC

MEDICARE: WHEELING RENAL CARE 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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center0579DCOH

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 : 1285630590
Entity Type Code : Organization
Provider Name (Legal Business Name) : WHEELING RENAL CARE LLC
Provider Business Mailing Address
First Line : 500 MEDICAL PARK
Second Line : STE 100
City : WHEELING
State : WV
Zip : 26003-7600
Country : US
Telephone Number : 304-242-7770
Fax Number : 304-243-3216
Provider Business Practice Location Address
First Line : 68639 BANNOCK RD
Second Line :
City : SAINT CLAIRSVILLE
State : OH
Zip : 43950-9736
Country : US
Telephone Number : 740-699-0220
Fax Number : 740-699-0703
Authorized Official
Title or Position : ASSISTANT ADMINISTRATOR
Name : MRS. DEBRA LUCKI
Credential : R.N.
Telephone Number : 304-242-7770
Provider Enumeration Date : 06/22/2005
Last Update Date : 08/22/2020

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Directions to “WHEELING RENAL CARE LLC ” Practice Location

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