Organization
TOTAL RENAL CARE INC
Active
Other names
Bay Shore 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
5650 N GREEN BAY AVE, SUITE 150, GLENDALE, WI 53209-4449
(414) 351-1290
(414) 351-1244
Mailing address
5200 VIRGINIA WAY, ATTN 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
—
1235457508
—
WI
Enumeration date
05/12/2010
Last updated
11/21/2024
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