Organization
TOTAL RENAL CARE INC
Active
Other names
Memphis Southeast 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
1805 MORIAH WOODS BLVD, STE 101, MEMPHIS, TN 38117-7121
(901) 685-3192
(901) 685-3645
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
174
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0442674
—
TN
05
—
08770897
—
MS
05
—
176757134
—
AR
Enumeration date
09/24/2007
Last updated
04/18/2024
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