Organization
TOTAL RENAL CARE INC
Active
Other names
Wautoma Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN D WINSTEL (CHIEF ACCOUNTING OFFICER)
(253) 733-4501
Entity
Organization
Contact information
Practice address
900 E DIVISION ST, WAUTOMA, WI 54982-6944
(920) 787-1031
(920) 787-1055
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
(615) 341-6264
(800) 297-2925
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
—
1750651600
—
WI
Enumeration date
01/10/2012
Last updated
10/18/2021
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