Organization Name: | WESTERN SKIES DIALYSIS INC |
NPI Number: | 1093864225 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JEAN LETARTE (PRESIDENT) |
Mailing Address: | 1041 N Arizola Rd Casa Grande |
State: | AZ US |
Postal Code: | 851226003 |
Phone Number: | 5208365883 |
Fax Number: | 5208362728 |
NPI Enumeration Date: | 01/09/2007 |
NPI Last Update Date: | 09/21/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | OTC 0576 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |