Organization
TOTAL RENAL CARE INC
Active
Other names
Diamond Speedway 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
1115 N NOVA RD, DAYTONA BEACH, FL 32117-4108
(386) 239-6877
(386) 239-5955
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
—
105554100
—
FL
Enumeration date
04/15/2019
Last updated
07/16/2024
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