MEDICARE: RENAL TREATMENT CENTERS SOUTHEAST LP

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

General Provider Information

NPI Number	:	1427316975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAL TREATMENT CENTERS SOUTHEAST LP

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	:	615-320-4550
Fax Number	:	866-500-8578

Provider Business Practice Location Address
First Line	:	2756 W TC JESTER BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-7003
Country	:	US
Telephone Number	:	713-680-9056
Fax Number	:	713-680-9310

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER
Name	:	JAMES K HILGER
Credential	:
Telephone Number	:	253-382-1919

Provider Enumeration Date	:	05/02/2012
Last Update Date	:	05/02/2012

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