Organization
TOTAL RENAL CARE INC
Active
Other names
Moscow Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
212 RODEO DR STE 110, MOSCOW, ID 83843-9791
(208) 882-5925
(208) 882-5926
Mailing address
5200 VIRGINIA WAY, ATT: 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
—
808543800
—
ID
Enumeration date
06/12/2009
Last updated
09/23/2025
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