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
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1588462469
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 DEPARTMENT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5117
Country	:	US
Telephone Number	:	615-935-2411
Fax Number	:

Provider Business Practice Location Address
First Line	:	2633 RANDLEMAN RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27406-5107
Country	:	US
Telephone Number	:	336-805-7018
Fax Number	:

Authorized Official
Title or Position	:	VP, LICENSURE & CERTIFICATION
Name	:	SAM T WEY
Credential	:
Telephone Number	:	615-341-6691

Provider Enumeration Date	:	03/05/2025
Last Update Date	:	03/05/2025

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