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NPI Code Detail

MEDICARE: TOTAL RENAL CARE INC

MEDICARE: TOTAL RENAL CARE INC
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
1261QE0700XEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number : 1265959142
Entity Type Code : Organization
Provider Name (Legal Business Name) : TOTAL RENAL CARE INC
Provider Business Mailing Address
First Line : 5200 VIRGINIA WAY
Second Line : L&C DEPARTMENT
City : BRENTWOOD
State : TN
Zip : 37027-7569
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4575 US HIGHWAY 17 STE 301
Second Line :
City : FLEMING ISLAND
State : FL
Zip : 32003-4825
Country : US
Telephone Number : 904-215-2476
Fax Number : 904-215-8344
Authorized Official
Title or Position : VP, LICENSURE & CERTIFICATION
Name : SAMUEL T WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 08/23/2017
Last Update Date : 12/10/2024

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