Organization
TOTAL RENAL CARE TEXAS LIMITED PARTNERSHIP
Active
Other names
Fourth Street 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
3101 4TH ST STE B, LONGVIEW, TX 75605-5146
(903) 234-0112
(903) 234-1341
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
007783
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
087932202
—
TX
Enumeration date
04/10/2006
Last updated
10/15/2025
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