Organization
TOTAL RENAL CARE INC
Active
Other names
Fayetteville 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
509 E MILLSAP RD, STE 111, FAYETTEVILLE, AR 72703-4862
(479) 443-6688
(479) 527-9917
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
—
100757230D
—
OK
05
—
168261134
—
AR
Enumeration date
02/11/2008
Last updated
01/09/2025
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