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General NPI Number Information
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NPI Number | 1174833057
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Entity Type | Organization
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Legal Business Name | TOOELE MOBILE DIALYSIS LLC
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 1298 E 850 N
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City | TOOELE
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State | UT
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Zip | 84074-8914
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Country | US
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Telephone | 801-867-7464
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Fax | 801-606-2950
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Provider Business Mailing Address
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Address Line | 1298 E 850 N
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City | TOOELE
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State | UT
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Zip | 84074-8914
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Country | US
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Telephone | 801-867-7464
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Fax | 801-606-2950
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Authorized Official
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Title or Position | CEO
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Name | HODSON JEAN
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Credential |
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Telephone | 801-867-7464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 2010216
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License Number State | UT
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