Provider Demographics
NPI:1295041291
Name:TOTAL RENAL CARE INC
Entity Type:Organization
Organization Name:TOTAL RENAL CARE INC
Other - Org Name:ROBBINSDALE DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:HILGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-382-1919
Mailing Address - Street 1:5200 VIRGINIA WAY
Mailing Address - Street 2:4TH FLOOR L&C DEPT
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7569
Mailing Address - Country:US
Mailing Address - Phone:615-341-6480
Mailing Address - Fax:866-381-9878
Practice Address - Street 1:3461 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2955
Practice Address - Country:US
Practice Address - Phone:763-521-4865
Practice Address - Fax:763-522-6754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2011-11-21
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
242582Medicare Oscar/Certification