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

General Provider Information

NPI Number	:	1982183224
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	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-320-4283
Fax Number	:

Provider Business Practice Location Address
First Line	:	251 MOUNT NEBO POINTE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-1313
Country	:	US
Telephone Number	:	412-364-3238
Fax Number	:	412-364-0523

Authorized Official
Title or Position	:	CAO
Name	:	JAMES HILGER
Credential	:
Telephone Number	:	310-536-2400

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	11/06/2019

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