MEDICARE: RENAL CENTER OF MOOREFIELD 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	:	1407893050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAL CENTER OF MOOREFIELD 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	:	615-238-3051
Fax Number	:	800-246-8346

Provider Business Practice Location Address
First Line	:	8 LEE ST
Second Line	:	FL 2
City	:	MOOREFIELD
State	:	WV
Zip	:	26836-1091
Country	:	US
Telephone Number	:	304-530-1200
Fax Number	:	304-530-1212

Authorized Official
Title or Position	:	SR DIRECTOR LICENSURE CERTIFICATION
Name	:	SAM T WEY
Credential	:	AUTHORIZED OFFICIAL
Telephone Number	:	615-341-6641

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	09/26/2023

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