MEDICARE: LAS VEGAS PEDIATRIC DIALYSIS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	5251ESR	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952570590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS PEDIATRIC DIALYSIS LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L&C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:	615-341-6814
Fax Number	:	800-293-8405

Provider Business Practice Location Address
First Line	:	7271 W SAHARA AVE STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2862
Country	:	US
Telephone Number	:	702-227-3049
Fax Number	:	702-227-8882

Authorized Official
Title or Position	:	CHIEF ACCOUNTING OFFICER
Name	:	JOHN WINSTEL
Credential	:
Telephone Number	:	253-733-4501

Provider Enumeration Date	:	02/28/2008
Last Update Date	:	06/01/2021

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Directions to “LAS VEGAS PEDIATRIC DIALYSIS LLC ” Practice Location

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