Organization
TOTAL RENAL CARE INC
Active
Other names
Lake Geneva 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
650 N EDWARDS BLVD, LAKE GENEVA, WI 53147-4595
(262) 248-2502
(262) 248-0316
Mailing address
5200 VIRGINIA WAY, ATTN: 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
—
1831469766
—
WI
Enumeration date
01/10/2012
Last updated
06/25/2024
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