Healthcare Provider Details

I. General information

NPI: 1134548662
Provider Name (Legal Business Name): SOUTHWEST LOUISIANA RENAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2014
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 WRIGHT AVE SUITE B
CROWLEY LA
70526-2226
US

IV. Provider business mailing address

1633 CHURCH ST SUITE 500
NASHVILLE TN
37203-2990
US

V. Phone/Fax

Practice location:
  • Phone: 337-788-2864
  • Fax: 337-788-2866
Mailing address:
  • Phone: 615-327-3061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DONOVAN SCHULTZ
Title or Position: PRESIDENT
Credential:
Phone: 615-327-3061