Provider Demographics
NPI:1376950345
Name:RENAL TREATMENT CENTERS SOUTHEAST LP
Entity Type:Organization
Organization Name:RENAL TREATMENT CENTERS SOUTHEAST LP
Other - Org Name:NORTH SHEPHERD DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINSTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-733-4501
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:615-320-4514
Mailing Address - Fax:866-594-9961
Practice Address - Street 1:7272 N SHEPHERD DR
Practice Address - Street 2:BLDG B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-2435
Practice Address - Country:US
Practice Address - Phone:713-697-1115
Practice Address - Fax:713-697-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2022-05-11
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
TX343935801Medicaid
672518Medicare Oscar/Certification