Healthcare Provider Details

I. General information

NPI: 1629030036
Provider Name (Legal Business Name): RENAL TREATMENT CENTERS WEST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 N 9TH ST
BROKEN ARROW OK
74012-8283
US

IV. Provider business mailing address

5200 VIRGINIA WAY STE 400 L&C
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 918-355-0657
  • Fax: 918-355-2800
Mailing address:
  • Phone: 615-341-5846
  • Fax: 866-566-2293

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: VICE PRESIDENT
Credential:
Phone: 253-382-1919