Organization
TRC - INDIANA LLC
Active
Other names
Comprehensive Renal Care East Chicago
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
4320 FIR ST UNIT 404, EAST CHICAGO, IN 46312-3078
(219) 397-1199
(219) 397-1625
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
—
200315330F
—
IN
05
—
=========
—
IL
Enumeration date
04/11/2006
Last updated
07/10/2024
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