Healthcare Provider Details

I. General information

NPI: 1861454969
Provider Name (Legal Business Name): RENAL TREATMENT CENTERS WEST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 VISTA BLVD STE 100
SPARKS NV
89436-1868
US

IV. Provider business mailing address

5200 VIRGINIA WAY STE 400
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 775-359-5432
  • Fax: 775-359-2885
Mailing address:
  • Phone: 615-320-4435
  • Fax: 303-209-7821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number489ESR11
License Number StateNV

VIII. Authorized Official

Name: THOMAS O USILTON JR.
Title or Position: GROUP VICE PRESIDENT
Credential:
Phone: 770-541-7922