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NPI Code Detail

MEDICARE: TOTAL RENAL CARE OF NORTH CAROLINA LLC

MEDICARE: TOTAL RENAL CARE OF NORTH CAROLINA LLC
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 : 1407815939
Entity Type Code : Organization
Provider Name (Legal Business Name) : TOTAL RENAL CARE OF NORTH CAROLINA LLC
Provider Business Mailing Address
First Line : 5200 VIRGINIA WAY
Second Line : L&C DEPT
City : BRENTWOOD
State : TN
Zip : 37027-7569
Country : US
Telephone Number : 615-320-4593
Fax Number : 800-293-5872
Provider Business Practice Location Address
First Line : 403 S MAIN ST
Second Line :
City : RAEFORD
State : NC
Zip : 28376-3222
Country : US
Telephone Number : 910-875-6561
Fax Number : 910-875-6652
Authorized Official
Title or Position : SR DIRECTOR,LICENSURE&CERTIFICATION
Name : SAMUEL T WEY
Credential :
Telephone Number : 615-341-6641
Provider Enumeration Date : 03/22/2006
Last Update Date : 08/09/2023

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Directions to “TOTAL RENAL CARE OF NORTH CAROLINA LLC ” Practice Location

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