Organization Name: | RENAL TREATMENT CENTERS SOUTHEAST LP |
NPI Number: | 1336483478 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES K HILGER (CHIEF ACCOUNTING OFFICER) |
Mailing Address: | 1023 Douglas Ave Ste 300 Brewton |
State: | AL US |
Postal Code: | 364261586 |
Phone Number: | 2518678509 |
Fax Number: | 2518677325 |
NPI Enumeration Date: | 11/15/2012 |
NPI Last Update Date: | 09/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | S2704 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |