Healthcare Provider Details

I. General information

NPI: 1366693186
Provider Name (Legal Business Name): RED ROCKS DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JUNCTION OF HWAY 371 & ROUTE 9
CROWNPOINT NM
87313
US

IV. Provider business mailing address

PO BOX 251549
PLANO TX
75025-1500
US

V. Phone/Fax

Practice location:
  • Phone: 505-786-5280
  • Fax:
Mailing address:
  • Phone: 214-736-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS L. WEINBERG
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 214-736-2700