Healthcare Provider Details

I. General information

NPI: 1699836411
Provider Name (Legal Business Name): METHODIST HEALTHCARE DIALYSIS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8071 WINCHESTER RD SUITE 3
MEMPHIS TN
38125-8206
US

IV. Provider business mailing address

6400 SHELBY VIEW DR SUITE 101
MEMPHIS TN
38134-7659
US

V. Phone/Fax

Practice location:
  • Phone: 901-759-2020
  • Fax: 901-759-2025
Mailing address:
  • Phone: 901-516-1400
  • Fax: 901-380-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number160
License Number StateTN

VIII. Authorized Official

Name: MR. JOHN MITCHELL GRAVES
Title or Position: PRESIDENT
Credential:
Phone: 901-516-1400