Organization
TOTAL RENAL CARE INC
Active
Other names
Goose Creek 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
109 GREENLAND DR, GOOSE CREEK, SC 29445-5354
(843) 377-1199
(843) 377-1262
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
ERD-0164
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42D1025040
—
AR
05
—
ERD164
—
SC
Enumeration date
04/04/2006
Last updated
11/27/2024
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