| Organization Name: | CLEWISTON DIALYSIS CENTER LLC |
| NPI Number: | 1144628017 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOHN J. MCDONOUGH (COO) |
| Mailing Address: | 851 W Ventura Ave Clewiston |
| State: | FL US |
| Postal Code: | 334403409 |
| Phone Number: | 8639838855 |
| Fax Number: | 8639835216 |
| NPI Enumeration Date: | 12/09/2014 |
| NPI Last Update Date: | 08/11/2015 |
| 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: | |