=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699721993
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENAL CENTER OF TRENTON, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2006
-----------------------------------------------------
Last Update Date | 04/03/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 HAMILTON AVE
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08629-1915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-393-2388
-----------------------------------------------------
Fax | 609-393-7927
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5200 VIRGINIA WAY L&C DEPT
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-7569
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-341-6410
-----------------------------------------------------
Fax | 888-662-8259
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF ACCOUNTING OFFICER
-----------------------------------------------------
Name | JOHN D WINSTEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-733-4501
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number | 007207
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------