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NPI Code Detail

MEDICARE: RENAL TREATMENT CENTERS MID ATLANTIC INC

MEDICARE: RENAL TREATMENT CENTERS MID ATLANTIC 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 : 1689638819
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENAL TREATMENT CENTERS MID ATLANTIC INC
Provider Business Mailing Address
First Line : 5200 VIRGINIA WAY
Second Line : STE 400 L&C
City : BRENTWOOD
State : TN
Zip : 37027-7569
Country : US
Telephone Number : 615-320-4218
Fax Number : 303-209-7825
Provider Business Practice Location Address
First Line : 1745 CAMELOT DR
Second Line : STE 100
City : VIRGINIA BEACH
State : VA
Zip : 23454-2435
Country : US
Telephone Number : 757-496-2300
Fax Number : 757-496-3490
Authorized Official
Title or Position : GROUP VICE PRESIDENT
Name : THOMAS O USILTON JR.
Credential :
Telephone Number : 770-541-7922
Provider Enumeration Date : 04/14/2006
Last Update Date : 01/29/2008

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Directions to “RENAL TREATMENT CENTERS MID ATLANTIC INC ” Practice Location

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