Organization Name: | WEST MONROE DIALYSIS LLC |
NPI Number: | 1104021724 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | THOMAS O USILTON (SR VICE PRESIDENT) |
Mailing Address: | 401 Thomas Rd West Monroe |
State: | LA US |
Postal Code: | 712927902 |
Phone Number: | 6153204435 |
Fax Number: | |
NPI Enumeration Date: | 06/15/2007 |
NPI Last Update Date: | 08/14/2007 |
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: |