Organization
TRC - INDIANA LLC
Active
Other names
Comprehensive Renal Care Michigan City
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (SR DIRECTOR LICENSURE&CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
9836 W 400 N, MICHIGAN CITY, IN 46360-2910
(219) 878-1989
(219) 878-9569
Mailing address
5200 VIRGINIA WAY, ATT: L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4514
(866) 594-9961
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
—
200315330D
—
IN
05
—
4355783
—
MI
Enumeration date
04/11/2006
Last updated
09/01/2023
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