Healthcare Provider Details

I. General information

NPI: 1730507732
Provider Name (Legal Business Name): HOT SPRINGS DIALYSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 PACIFIC AVE
TACOMA WA
98402-4203
US

IV. Provider business mailing address

115 WRIGHTS ST STE A
HOT SPRINGS AR
71913-6240
US

V. Phone/Fax

Practice location:
  • Phone: 253-382-1752
  • Fax:
Mailing address:
  • Phone: 501-624-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number1881938207
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number04D0642393
License Number StateAR

VIII. Authorized Official

Name: KENT THIRY
Title or Position: CEO
Credential: CHAIRMAN
Phone: 303-876-6000