TOTAL RENAL CARE INC NPI 1720242779

NPI Information

NPI: 1720242779
Provider Name: TOTAL RENAL CARE INC

Doing Business As: VIDALIA FIRST STREET DIALYSIS

Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

Address:
906 E 1ST ST
VIDALIA, GA
ZIP 30474
Phone: (912) 538-8908
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TOTAL RENAL CARE INC is an end-stage renal disease (esrd) treatment clinic center in Vidalia, GA. TOTAL RENAL CARE INC NPI is 1720242779. The provider is registered as an organization entity type.
The provider Is Doing Business As Vidalia First Street Dialysis.

The provider's business location address is:

906 E 1ST ST
VIDALIA, GA
ZIP 30474-207
Phone: (912) 538-8908
Fax: (912) 538-8909

The provider's authorized official is John Winstel .
The authorized official title is Chief Accounting Officer and has the following contact phone number (253) 733-4501.

The CLIA number assigned to this NPI record is 11D0997271 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/17/2008 and was last updated on 7/7/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment	ESRD001220	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000972529C	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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