MEDICARE: RENAL CENTER OF NORTH DENTON, LLLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	008212	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063457240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAL CENTER OF NORTH DENTON, LLLP

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L&C DEPARTMENT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4309 MESA DR
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76207-3438
Country	:	US
Telephone Number	:	940-566-2701
Fax Number	:	940-483-8251

Authorized Official
Title or Position	:	VP LICENSURE&CERTIFICATION
Name	:	SAMUEL T WEY
Credential	:
Telephone Number	:	615-341-6641

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	04/23/2025

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