Organization
TOTAL RENAL CARE INC
Active
Other names
Manitowoc Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
3303 DEWEY ST, ATTN DIALYSIS UNIT, MANITOWOC, WI 54220-5987
(920) 652-0593
(920) 686-0550
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134499080
—
WI
Enumeration date
01/10/2012
Last updated
09/19/2024
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