Provider Demographics
NPI:1578523379
Name:RENAL TREATMENT CENTERS MID ATLANTIC INC
Entity Type:Organization
Organization Name:RENAL TREATMENT CENTERS MID ATLANTIC INC
Other - Org Name:PIKESVILLE DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER
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:253-733-4500
Mailing Address - Street 1:5200 VIRGINIA WAY
Mailing Address - Street 2:L & C DEPARTMENT
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7569
Mailing Address - Country:US
Mailing Address - Phone:615-320-4230
Mailing Address - Fax:866-376-5823
Practice Address - Street 1:6609 REISTERSTOWN RD
Practice Address - Street 2:STE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2315
Practice Address - Country:US
Practice Address - Phone:410-358-1745
Practice Address - Fax:410-358-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDE2636261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4104879200Medicaid
MD212336Medicare Oscar/Certification