Organization Name: | ISD RENAL INC |
NPI Number: | 1023064474 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES K HILGER (CHIEF ACCOUNTING OFFICER) |
Mailing Address: | 1510 Division St Ste 90 Oregon City |
State: | OR US |
Postal Code: | 970451572 |
Phone Number: | 5035571373 |
Fax Number: | 5035571087 |
NPI Enumeration Date: | 05/26/2006 |
NPI Last Update Date: | 06/27/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |