=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417234725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOTAL RENAL CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2011
-----------------------------------------------------
Last Update Date | 11/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1575 NORTHSIDE DR NW SUITE 355
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30318-4210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-352-1870
-----------------------------------------------------
Fax | 404-352-3107
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5200 VIRGINIA WAY L&C DEPT
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-7569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-320-4268
-----------------------------------------------------
Fax | 877-238-0567
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT, LICENSURE & CERTIFI
-----------------------------------------------------
Name | SAMUEL T WEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-341-6641
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number | ESRD001275
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------