1013000603 NPI number — RAI CARE CENTERS OF MARYLAND I, LLC

Table of content: (NPI 1013000603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013000603 NPI number — RAI CARE CENTERS OF MARYLAND I, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAI CARE CENTERS OF MARYLAND I, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
U.S. RENAL CARE OXON HILLS DIALYSIS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013000603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1550 W. MCEWEN DRIVE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37067-1731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-661-1100
Provider Business Mailing Address Fax Number:
615-507-3300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5410 INDIAN HEAD HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXON HILL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20745-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-749-9307
Provider Business Practice Location Address Fax Number:
301-749-9419
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEINBERG
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
214-736-2700

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 184608 . This is a "ANTHEM VA BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 88170901 . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 409585500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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