1043457484 NPI number — RENAL TREATMENT CENTERS SOUTHEAST LP

Table of content: MS. DENEDRIA RENEE BANKS LCSW (NPI 1447816061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043457484 NPI number — RENAL TREATMENT CENTERS SOUTHEAST LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENAL TREATMENT CENTERS SOUTHEAST LP
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:
Provider Other Organization Name Type Code:
6
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:
1043457484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5200 VIRGINIA WAY
Provider Second Line Business Mailing Address:
L&C DEPT 4TH FLOOR
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-7569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-320-4550
Provider Business Mailing Address Fax Number:
866-500-8578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5036 TENNYSON PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75024-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-608-1089
Provider Business Practice Location Address Fax Number:
972-608-1096
Provider Enumeration Date:
01/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HILGER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CHIEF ACCOUNTING OFFICER
Authorized Official Telephone Number:
253-382-1919

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  110009 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 219313801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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