| Organization Name: | DIALYSIS CENTERS OF NORTHWEST ARKANSAS, LLC |
| NPI Number: | 1437236908 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT BOMSTAD (ADMINISTRATOR) |
| Mailing Address: | 2125 E Main St Suite 11 & 12 Siloam Springs |
| State: | AR US |
| Postal Code: | 727615571 |
| Phone Number: | 4795245214 |
| Fax Number: | |
| NPI Enumeration Date: | 11/01/2006 |
| NPI Last Update Date: | 03/20/2015 |
| 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: | |