| Organization Name: | PEDERNALES DIALYSIS LLC |
| NPI Number: | 1013310150 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES K HILGER (CHIEF ACCOUNTING OFFICER) |
| Mailing Address: | 213 Delores St Colquitt |
| State: | GA US |
| Postal Code: | 398373528 |
| Phone Number: | 2297581985 |
| Fax Number: | 2297582555 |
| NPI Enumeration Date: | 10/03/2014 |
| NPI Last Update Date: | 04/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |