Renal Treatment Centers-Southeast, LP.

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

RENAL TREATMENT CENTERS-SOUTHEAST, LP.

Doing business as

Forrest City Dialysis

Practice address

1501 N Washington St
Forrest City, AR 72335-2152

Phone

(870) 494-4022

Fax

(870) 494-4769

NPI assigned

Feb 19, 2010

Last updated

Oct 29, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Samuel T Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Forrest City Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Tax ID family

Bradley County Dialysis137 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 6

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Renal Treatment Centers-Southeast, LP.

  dba DeGray Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Arkadelphia, AR
  • NPI 1184968604
  NPD tax ID
• Renal Treatment Centers-Southeast, LP.

  dba River Valley Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Russellville, AR
  • NPI 1285978627
  NPD tax ID
• Renal Treatment Centers-Southeast, LP.

  dba South Little Rock Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Little Rock, AR
  • NPI 1396178471
  NPD tax ID
• Renal Treatment Centers-Southeast, LP.

  dba South Arkansas Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • El Dorado, AR
  • NPI 1508100017
  NPD tax ID
• Renal Treatment Centers-Southeast, LP.

  dba Malvern Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockport, AR
  • NPI 1700120110
  NPD tax ID
• Renal Treatment Centers-Southeast, LP.

  dba Ouachita Valley Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Camden, AR
  • NPI 1891039210
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1457673345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 N WASHINGTON ST",
            "city": "FORREST CITY",
            "state": "AR",
            "postal_code": "723352152",
            "telephone_number": "870-494-4022",
            "fax_number": "870-494-4769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL TREATMENT CENTERS-SOUTHEAST, LP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-19",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204095134",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forrest City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Forrest City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tyneika Redden
• Donna Redmon
• Jennifer Reeves, LPN
• Piper Reeves
• Gwendoyln Reid, MHPP
• Shanice Rice
• Ridgeline Obstetrics & Gynecology
• Latara Ridgell, MHPP
• Cherie Roberts
• Brenda Joyce Robinson, LPN, A.A.S., MHPP

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Forrest City, AR
• Providers in Forrest City, AR by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.