Healthcare Provider Details

I. General information

NPI: 1235360900
Provider Name (Legal Business Name): RENAL TREATMENT CENTERS - SOUTHEAST LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 HESTER PARKER DR
MARKED TREE AR
72365-2023
US

IV. Provider business mailing address

5200 VIRGINIA WAY L&C DEPT
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 870-358-1130
  • Fax: 870-358-1135
Mailing address:
  • Phone: 615-341-6376
  • Fax: 877-471-9926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES K HILGER
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 253-733-4500