Organization
TOTAL RENAL CARE INC
Active
Other names
Lost River Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
737 DISHMAN LANE EXT, BOWLING GREEN, KY 42104-3898
(270) 846-1054
(270) 846-2866
Mailing address
5200 VIRGINIA WAY, L&C DEPARTMENT, BRENTWOOD, TN 37027-7569
(615) 238-3051
(800) 246-8346
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
01
—
300282
STATE LICENSE
KY
05
—
7100573280
—
KY
Enumeration date
08/18/2017
Last updated
10/22/2020
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