Organization Name: | PINE BLUFF DIALYSIS INC |
NPI Number: | 1720065675 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | THOMAS L WEINBERG (VICE PRESIDENT GENERAL COUNSEL) |
Mailing Address: | 610 Holly St Mc Gehee |
State: | AR US |
Postal Code: | 716542109 |
Phone Number: | 8702226700 |
Fax Number: | 8702226203 |
NPI Enumeration Date: | 12/30/2005 |
NPI Last Update Date: | 01/23/2013 |
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: |