=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164617361
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTAL RENAL CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2007
-----------------------------------------------------
Last Update Date | 09/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 PANCHERI DR STE B
-----------------------------------------------------
City | IDAHO FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83402-3310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-524-1336
-----------------------------------------------------
Fax | 208-524-7452
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5200 VIRGINIA WAY STE 400 L&C
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-7569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-320-4435
-----------------------------------------------------
Fax | 303-209-7821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SR VICE PRESIDENT
-----------------------------------------------------
Name | THOMAS O USILTON JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-541-7922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------