Organization
TOTAL RENAL CARE INC
Active
Other names
South Bend West 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
5660 NIMTZ PKWY, SOUTH BEND, IN 46628-6205
(574) 231-7570
(574) 231-7571
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
—
201281460A
—
IN
Enumeration date
08/08/2014
Last updated
08/12/2024
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