Healthcare Provider Details

I. General information

NPI: 1407893050
Provider Name (Legal Business Name): RENAL CENTER OF MOOREFIELD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LEE ST FL 2
MOOREFIELD WV
26836-1091
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 304-530-1200
  • Fax: 304-530-1212
Mailing address:
  • Phone: 615-238-3051
  • Fax: 800-246-8346

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: SAM T WEY
Title or Position: SR DIRECTOR LICENSURE CERTIFICATION
Credential: AUTHORIZED OFFICIAL
Phone: 615-341-6641