MEDICARE: RAI CARE CENTERS OF CLINTON 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

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	:	1588890024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAI CARE CENTERS OF CLINTON LLC

Provider Business Mailing Address
First Line	:	424 CHURCH ST
Second Line	:	SUITE 1900
City	:	NASHVILLE
State	:	TN
Zip	:	37219-2301
Country	:	US
Telephone Number	:	615-777-8201
Fax Number	:

Provider Business Practice Location Address
First Line	:	7201 OLD ALEXANDRIA FERRY ROAD
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-1865
Country	:	US
Telephone Number	:	615-661-1100
Fax Number	:	615-507-3300

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	THOMAS L. WEINBERG
Credential	:
Telephone Number	:	214-736-2700

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	02/15/2016

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