1699962282 NPI number — RENAL TREATMENT CENTERS SOUTHEAST LP

Table of content: (NPI 1699962282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699962282 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:
1699962282
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2018
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
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:
615-320-4268
Provider Business Mailing Address Fax Number:
877-238-0567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27880 N MAIN ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
DAPHNE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36526-7080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-626-1086
Provider Business Practice Location Address Fax Number:
251-626-4056
Provider Enumeration Date:
09/27/2007

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:
253-733-4500

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  S0205 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 107341 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: S0205 . This is a "STATE LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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