TOTAL RENAL CARE INC NPI 1255587531

NPI Information

  • NPI: 1255587531
  • Provider Name: TOTAL RENAL CARE INC
  • Classification: Clinic/Center - 261QE0700X
  • Specialization: End-Stage Renal Disease (ESRD) Treatment
  • Entity Type: Organization
  • Doing Business As: JACKSONVILLE SOUTH DIALYSIS CENTER
  • CLIA Number: 10D1090544
  • Address: 14965 OLD SAINT AUGUSTINE RD
    UNIT 114
    JACKSONVILLE, FL
    ZIP 32258
  • Phone: (904) 880-9494

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NPI Details

TOTAL RENAL CARE INC is an end-stage renal disease (esrd) treatment clinic center in Jacksonville, FL. TOTAL RENAL CARE INC NPI is 1255587531. The provider is registered as an organization entity type.
The provider Is Doing Business As Jacksonville South Dialysis Center.

The provider's business location address is:

14965 OLD SAINT AUGUSTINE RD
UNIT 114
JACKSONVILLE, FL
ZIP 32258-481
Phone: (904) 880-9494
Fax: (904) 880-0295

The provider's authorized official is Samuel T Wey .
The authorized official title is VP, LICENSURE & CERTIFICATIONLicensure & Certification and has the following contact phone number (615) 341-6641.

The CLIA number assigned to this NPI record is 10D1090544 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/18/2008 and was last updated on 1/10/2024.

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
1261QE0700XClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentYes

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
1001159900MEDICAIDFLORIDA

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: 3/30/2025

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