Organization Name: | BLACKHILLS DIALYSIS, L.L.C. |
NPI Number: | 1316147440 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LOUIS C RAYMOND (MEDICAL DIRECTOR) |
Mailing Address: | Main Street Eagle Butte |
State: | SD US |
Postal Code: | 57625 |
Phone Number: | 6059642311 |
Fax Number: | 6059642313 |
NPI Enumeration Date: | 07/18/2007 |
NPI Last Update Date: | 07/18/2007 |
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: |