Organization Name: | TOOELE MOBILE DIALYSIS LLC |
NPI Number: | 1174833057 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HODSON JEAN (CEO) |
Mailing Address: | 1298 E 850 N Tooele |
State: | UT US |
Postal Code: | 840748914 |
Phone Number: | 8018677464 |
Fax Number: | 8016062950 |
NPI Enumeration Date: | 10/13/2010 |
NPI Last Update Date: | 10/13/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | 2010216 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |