Healthcare Provider Details

I. General information

NPI: 1346203825
Provider Name (Legal Business Name): GREATER LAS VEGAS DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 S RANCHO DR STE 115
LAS VEGAS NV
89102-4456
US

IV. Provider business mailing address

5200 VIRGINIA WAY L&C DEPARTMENT
BRENTWOOD TN
37027-7569
US

V. Phone/Fax

Practice location:
  • Phone: 702-795-1771
  • Fax: 702-795-1794
Mailing address:
  • Phone: 615-341-6814
  • Fax: 800-293-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number2948ESR
License Number StateNV

VIII. Authorized Official

Name: JOHN D WINSTEL
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 253-733-4501