Basic Information
Provider Information
NPI: 1851689335
EntityType: 2
ReplacementNPI:  
OrganizationName: TOTAL RENAL CARE INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ARNOLD DIALYSIS
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5200 VIRGINIA WAY
Address2: STE 400
City: BRENTWOOD
State: TN
PostalCode: 370277569
CountryCode: US
TelephoneNumber: 6153416480
FaxNumber: 8663819878
Practice Location
Address1: 102 RICHARDSON XING
Address2:  
City: ARNOLD
State: MO
PostalCode: 630106023
CountryCode: US
TelephoneNumber: 6364675619
FaxNumber: 6364675997
Other Information
ProviderEnumerationDate: 07/18/2011
LastUpdateDate: 03/27/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HILGER
AuthorizedOfficialFirstName: JAMES
AuthorizedOfficialMiddleName: K
AuthorizedOfficialTitleorPosition: CHIEF ACCOUNTING OFFICER
AuthorizedOfficialTelephone: 2533821919
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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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