Provider Demographics
NPI:1164486288
Name:RENAL TREATMENT CENTERS WEST INC
Entity Type:Organization
Organization Name:RENAL TREATMENT CENTERS WEST INC
Other - Org Name:BELLEVUE DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP LICENSURE & CERTIFICATION
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-341-6641
Mailing Address - Street 1:5200 VIRGINIA WAY
Mailing Address - Street 2:L&C DEPT
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7569
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3535 FACTORIA BLVD SE
Practice Address - Street 2:STE 150
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1293
Practice Address - Country:US
Practice Address - Phone:425-641-6514
Practice Address - Fax:425-641-6518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3990876Medicaid
502542Medicare Oscar/Certification