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NPI 1679944003

NPI 1679944003 : TOTAL RENAL CARE INC : SUMMERVILLE, SC

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General NPI Number Information
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    NPI Number           |    1679944003
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    Entity Type          |    Organization 
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    Legal Business Name  |    TOTAL RENAL CARE INC 
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Dates
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    Enumeration Date     |    10/12/2015
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    Last Update Date     |    10/17/2025
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Provider Practice Location Address
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    Address Line         |    2897 W 5TH NORTH ST 
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    City                 |    SUMMERVILLE
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    State                |    SC
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    Zip                  |    29483-9674
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    Country              |    US
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    Telephone            |    843-873-3955
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    Fax                  |    843-873-0266
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Provider Business Mailing Address
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    Address Line         |    5200 VIRGINIA WAY L&C DEPT
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    City                 |    BRENTWOOD
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    State                |    TN
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    Zip                  |    37027-7569
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    Country              |    US
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    Telephone            |    
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    Fax                  |    
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Authorized Official
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    Title or Position    |    VP, LICENSURE & CERTIFICATION
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    Name                 |     SAMUEL T WEY 
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    Credential           |    
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    Telephone            |    615-341-6641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    261QE0700X
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    Taxonomy Name        |    End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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    License Number       |    ERD-0183
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    License Number State |    SC
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