Basic Information
Provider Information
NPI: 1134593239
EntityType: 2
ReplacementNPI:  
OrganizationName: DSI TRAVELERS REST, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: U.S. RENAL CARE TRAVELERS REST DIALYSIS
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 424 CHURCH ST
Address2: SUITE 1900
City: NASHVILLE
State: TN
PostalCode: 372192301
CountryCode: US
TelephoneNumber: 6154670131
FaxNumber: 6152342422
Practice Location
Address1: 36 S MAIN ST
Address2:  
City: TRAVELERS REST
State: SC
PostalCode: 296901872
CountryCode: US
TelephoneNumber: 8646602050
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/30/2015
LastUpdateDate: 05/19/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: WEINBERG
AuthorizedOfficialFirstName: THOMAS
AuthorizedOfficialMiddleName: L.
AuthorizedOfficialTitleorPosition: AUTHORIZED OFFICIAL
AuthorizedOfficialTelephone: 2147362700
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: U.S RENAL CARE, INC.
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QE0700X  Y Ambulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment

No ID Information.


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