Organization Name: | BOLTRON DIALYSIS LLC |
NPI Number: | 1952726515 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES K HILGER (CHIEF ACCOUNTING OFFICER) |
Mailing Address: | 965 E Division St Ste 100 Coal City |
State: | IL US |
Postal Code: | 604169483 |
Phone Number: | 6153416657 |
Fax Number: | 8666519495 |
NPI Enumeration Date: | 02/19/2014 |
NPI Last Update Date: | 05/14/2014 |
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: |