Organization
TOTAL RENAL CARE INC
Active
Other names
Jacksonville South 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
14965 OLD SAINT AUGUSTINE RD, UNIT 114, JACKSONVILLE, FL 32258-9481
(904) 880-9494
(904) 880-0295
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
—
001159900
—
FL
Enumeration date
08/18/2008
Last updated
06/13/2025
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