Healthcare Provider Details

I. General information

NPI: 1477704997
Provider Name (Legal Business Name): RED ROCKS DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 D AVE
ZUNI NM
87327-4120
US

IV. Provider business mailing address

2400 DALLAS PKWY STE 350
PLANO TX
75093-4370
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-5663
  • Fax:
Mailing address:
  • Phone: 214-736-2700
  • Fax: 214-736-2701

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