Organization
TOTAL RENAL CARE OF NORTH CAROLINA LLC
Active
Other names
Southeastern Dialysis Center Jacksonville
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
14 OFFICE PARK DR, JACKSONVILLE, NC 28546-7325
(910) 353-6888
(910) 353-6839
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
—
3422532
—
NC
Enumeration date
03/22/2006
Last updated
05/31/2024
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