Basic Information
Provider Information
NPI: 1962773697
EntityType: 2
ReplacementNPI:  
OrganizationName: TOTAL RENAL CARE INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: GREER SOUTH HOME TRAINING
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
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Mailing Information
Address1: 5200 VIRGINIA WAY
Address2: 4TH FLOOR L&C DEPARTMENT
City: BRENTWOOD
State: TN
PostalCode: 370277569
CountryCode: US
TelephoneNumber: 6153204230
FaxNumber: 8663765823
Practice Location
Address1: 3254 BUSHY CREEK ROAD
Address2: SUITE A
City: GREER
State: SC
PostalCode: 296501000
CountryCode: US
TelephoneNumber: 8648779157
FaxNumber: 8648791831
Other Information
ProviderEnumerationDate: 01/26/2012
LastUpdateDate: 01/26/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HILGER
AuthorizedOfficialFirstName: JAMES
AuthorizedOfficialMiddleName: K
AuthorizedOfficialTitleorPosition: CHIEF ACCOUNTING OFFICER
AuthorizedOfficialTelephone: 2533821919
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
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AuthorizedOfficialCredential:  
NPICertificationDate:  

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

No ID Information.


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