Organization
TRC - PETERSBURG LLC
Active
Other names
Petersburg 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
20 MEDICAL PARK BLVD, PETERSBURG, VA 23805-9280
(804) 861-0967
(804) 861-0796
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
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366406613
—
VA
Enumeration date
04/13/2006
Last updated
04/16/2026
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