Organization
RENAL TREATMENT CENTERS-SOUTHEAST, LP.
Active
Other names
Malvern Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICAITON)
(615) 341-6641
Entity
Organization
Contact information
Practice address
1590 TANNER ST, ROCKPORT, AR 72104-2023
(501) 332-3000
(501) 332-5858
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 320-4268
(877) 238-0567
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
—
198764134
—
AR
Enumeration date
11/26/2012
Last updated
03/12/2024
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