Healthcare Provider Details

I. General information

NPI: 1518934702
Provider Name (Legal Business Name): TOTAL RENAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 LELARAY ST STE 130
COLORADO SPRINGS CO
80909-2804
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 719-471-4615
  • Fax: 719-471-0621
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number0561
License Number StateCO

VIII. Authorized Official

Name: SAMUEL T WEY
Title or Position: VP LICENSE & CERTIFICATION
Credential:
Phone: 615-341-6641